John Myburgh is a South African-born, Australian Intensive Care clinician- researcher. He has worked at the coal face in the ICU for the last 35 years, and led national and international research programs over the last 25 years directed at answering fundamental clinical questions to improve the lives of critically ill patients and their families. An avid teacher and mentor, he has based his style on his mentors who always stressed that the patient comes first, that teaching others was both a privilege and a duty and to question everything, particularly fundamentalism and dogma. A a SMACC Frequent Flyer, John is a dedicated rower on Middle Harbour in Sydney, the proud owner of 4 guitars (including a Fender Strat and Tele) and devoted Dad.
Does oxygen delivery matter?
The belief that pushing oxygen delivery with synthetic catecholamines is based on a physiological fallacy, fuelled by Bad Pharma
For the 30 years, clinical understanding of haemodynamic resuscitation has been based on physiological paradigms that focus on convective oxygen delivery. Most of these emphasise the role of cardiac output, haemoglobin and recommend interventions using synthetic agents such as dobutamine, synthetic colloids and blood transfusions. Markedly influenced by industry, these interventions and strategies hijacked critical thinking creating a belief in the utiliity of attaining short-term physiological surrogates for resuscitation that have little relevance in improving patient-centred outcomes. This ‘physiological fallacy’ has been demonstrated in high-quality RCTs of fluids, goal-directed therapy and catecholamines, that paradoxically inform the interpretation of new insights in the physiological basis of health and disease.