Critical care medicine pushes boundaries. We talk about personalized medicine and wax poetic on sophisticated trial design, all while debating using diaphragmatic ultrasound for ventilator weaning. Our excitement about the latest mechanical circulatory support device or novel vasopressor is matched only by the rush to share the latest “groundbreaking” meta-analysis – inevitably analyzing the same five trials as the last one, just with a different statistical twist. None of this is to say that such discussions do not have merit. But our fascination with tomorrow’s breakthroughs disguises a more fundamental challenge: we consistently fail to deliver basic, routine care at the bedside.[More]