I agree that clustering patients into syndromes has its limitations. The current clusters are nowhere near perfect. However, I disagree that this is not worth studying. Many patients with different etiologies of critical illness share common pathways that may benefit from a particular treatment.

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Other disciplines have shown the benefits of identifying disease behaviours. An example is the idea of a progressive fibrotic phenotype in ILD, which now has therapies that have shown benefit despite the underlying entities being heterogeneous (IPF, Fibrotic HP, NSIP, etc.).

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In critical illness, we know patients are “sick” & we use terms like “significant inflammatory process” but we aren’t able to quantify it. Proud to be part of this work where we showed the role of neutrophil extracellular traps in organ injury #sepsis ccforum.biomedcentral.com/articles/10....

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there are a lot of fine lines to be walked one I think about a lot: - confident enough to be assertive - humble enough to listen with an open mind @cliffreid.bsky.social has talked about this in the past: balancing confidence & experience. it’s hard.

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I do like DAGs for expressing our current best knowledge about a system. But then I really like RCTs because it mitigates the need to control for any of that complexity.

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