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the cause&#8211;effect relationship regarding the efficacy of a treatment &#40;HFNO&#41; vs&#46; another &#40;IMV&#41; cannot be rigorously argued if it is not demonstrated that the two cohorts &#40;with and without treatment&#41; were similar before applying the respective treatments&#46; The authors do not present a table showing the distribution of the covariates in both cohorts before the treatment was applied&#46; And therefore&#44; we do not know the confounding factors that should have been controlled for in the analysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We did find some data that makes us believe that IMV was applied to patients with a higher probability of dying&#46; Thus&#44; they indicate that &#8220;<span class="elsevierStyleItalic">patients were placed in HFNO if they had ventilatory failure&#8221;&#44;</span> but that &#8220;<span class="elsevierStyleItalic">patients that had severely altered consciousness at admission&#44; severe work of breathing &#40;exhaustion&#41;&#44; or shock were placed on invasive mechanical ventilation&#8221;&#46;</span> Survival of &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; patients who received IMV was 42&#46;2&#37;&#46; And of those &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41; who received HFNO at some point in their evolution&#44; 35 &#40;58&#37;&#41; could be weaned from HFNO and went home&#44; but in 25 &#40;42&#37;&#41; of them the treatment failed&#46; Of these&#44; 24 had to be intubated and 13 finally died &#40;21&#46;67&#37; mortality&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients where HFNO failed &#40;Tables 1 and 2&#41; were much more severe than those where it worked&#46; So&#44; since the assignment of patients to treatments was not random&#44; it is logical to deduce that the IMV had to deal with the most seriously ill&#46; 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that IMV fulfills its function better than HFNO is 61&#46;8&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So&#44; to our knowledge&#44; statements such as &#8220;We show evidence of the utility of HFNO in severe covid-19 patients that required ICU admission for the treatment of severe respiratory failure&#46; We achieved a high survival and posterior discharge rate&#8221; are far from having endured a rigorous experimental rebuttal and must still remain in the degree of belief&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval and consent to participate</span><p id="par0030" class="elsevierStylePara elsevierViewall">Consent for publication&#44; availability of data and material&#58; Not applicable&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contribution</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors contributed equally to this manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no competing interest&#46;</p></span></span>"
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Scientific letter
The science of truth
La ciencia de la verdad
A. Fajardoa,
,1
, R. Adasmeb,1, A. Medinac,1, V. Modesto i Alapontd,1
a Internal Medicine Service and Critical Patient Unit, Viña del Mar, Chile
b Respiratory Therapy UC-Christus Health Network Clinical Hospital, School of Kinesiology, Faculty of Rehabilitation, Andres Bello University, Santiago, Chile
c Central University Hospital of Asturias, Oviedo, Spain
d Hospital Universitari i Politècnic La Fe, València, Spain
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the cause&#8211;effect relationship regarding the efficacy of a treatment &#40;HFNO&#41; vs&#46; another &#40;IMV&#41; cannot be rigorously argued if it is not demonstrated that the two cohorts &#40;with and without treatment&#41; were similar before applying the respective treatments&#46; The authors do not present a table showing the distribution of the covariates in both cohorts before the treatment was applied&#46; And therefore&#44; we do not know the confounding factors that should have been controlled for in the analysis&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">We did find some data that makes us believe that IMV was applied to patients with a higher probability of dying&#46; Thus&#44; they indicate that &#8220;<span class="elsevierStyleItalic">patients were placed in HFNO if they had ventilatory failure&#8221;&#44;</span> but that &#8220;<span class="elsevierStyleItalic">patients that had severely altered consciousness at admission&#44; severe work of breathing &#40;exhaustion&#41;&#44; or shock were placed on invasive mechanical ventilation&#8221;&#46;</span> Survival of &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30&#41; patients who received IMV was 42&#46;2&#37;&#46; And of those &#40;<span class="elsevierStyleItalic">n</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>60&#41; who received HFNO at some point in their evolution&#44; 35 &#40;58&#37;&#41; could be weaned from HFNO and went home&#44; but in 25 &#40;42&#37;&#41; of them the treatment failed&#46; Of these&#44; 24 had to be intubated and 13 finally died &#40;21&#46;67&#37; mortality&#41;&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">The patients where HFNO failed &#40;Tables 1 and 2&#41; were much more severe than those where it worked&#46; So&#44; since the assignment of patients to treatments was not random&#44; it is logical to deduce that the IMV had to deal with the most seriously ill&#46; This is clearly a co-intervention bias&#46; And despite this&#44; we can calculate that the IMV was quite effective&#44; in the sense of achieving the objective for which it was administered&#46; Since IMV was applied to 30<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>24<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>54 patients&#44; with a total of 17<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span>13<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>30 deaths&#44; it worked in more than 55&#46;56&#37; of the patients where it was applied&#46; HFNO only fulfilled its function in 58&#37; of the patients where it was used&#44; and who were the healthiest&#46; Using a beta-binomial Bayesian model&#44; and a non-informative a priori distribution&#44; the probability &#40;rational belief&#41; that IMV fulfills its function better than HFNO is 61&#46;8&#37;&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">So&#44; to our knowledge&#44; statements such as &#8220;We show evidence of the utility of HFNO in severe covid-19 patients that required ICU admission for the treatment of severe respiratory failure&#46; We achieved a high survival and posterior discharge rate&#8221; are far from having endured a rigorous experimental rebuttal and must still remain in the degree of belief&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Ethics approval and consent to participate</span><p id="par0030" class="elsevierStylePara elsevierViewall">Consent for publication&#44; availability of data and material&#58; Not applicable&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Authors&#8217; contribution</span><p id="par0035" class="elsevierStylePara elsevierViewall">All authors contributed equally to this manuscript&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Funding</span><p id="par0040" class="elsevierStylePara elsevierViewall">Not applicable&#46;</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Conflict of interest</span><p id="par0045" class="elsevierStylePara elsevierViewall">The authors declare no competing interest&#46;</p></span></span>"
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Article information
ISSN: 21735727
Original language: English
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