Question special

The ADRENAL and APROCCHS trials dwarfed the previous corticosteroids and septic shock studies. They had significantly larger sample sizes, spanned a multitude of intensive care units, and the ADRENAL team consisted of ICUs from five different countries covering three continents. This all amounts to years of work and meticulous planning. Along the way, there were likely some foreseen and unforeseen obstacles. What were some of the challenges or obstacles that you faced in designing and implementing these large critical care trials and how did you overcome them?