Rivers has big problems with the Corticus trial

I talked with Rivers today (yes, THAT Rivers) about the Corticus Trial. For those of you unfamiliar with the Corticus Trial, it's the steroid trial that showed that steroids in the ICU has no benefit and may show harm.

Rivers has some problems with it namely:
1) It's underpowered
2) They had to stop the study early because they ran out of study drug and money, so they published before they got enough patients (see #1)
3) The enrolled people up to 72 hours after onset of sepsis.

It's this final point that Rivers has a big problem with. His contention is that by 72 hours, the cat is out of the bag, out of the barn, and halfway to the moon (to mix a few metaphors--my metaphors, not his). So of course, there was no benefit. An analogy (also mine) would be to say that antibiotics don't work in sepsis because the antibiotic isn't given until 3 days after onset of symptoms. Okay not a great analogy, but you get the point.

Rivers still uses steroids, but waits until the patients have been adequately resuscitated (after 6 hours or so). If the patient is still pressor dependent he will start steroids at a dose of 50 mg hydrocortisone q6 hours.