CHEST Guidelines-Fibroproliferative-ARDS-in-the-Era-of-Low-Tidal-Vo

Fibroproliferative-ARDS-in-the-Era-of-Low-Tidal-Vo

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The editorial discusses the risks associated with sepsis and atrial fibrillation (AF), and highlights findings from Walkey et al. regarding the persistent occurrence of AF in sepsis survivors, which associates with higher mortality, stroke, and heart failure risk. They emphasize the importance of risk assessment using tools like the CHA2DS2-VASc score to predict long-term outcomes and advocate for potential therapies to mitigate sepsis-induced AF, while cautioning against the use of systemic steroids.<br /><br />In a separate editorial by Manu Jain, the focus is on Acute Respiratory Distress Syndrome (ARDS) in the current era of low-tidal-volume ventilation. Despite improved survival rates, ARDS survivors face diminished long-term health-related quality of life (HRQoL), often due to neuromuscular and psychosocial dysfunction. However, recent studies, including those by Burnham et al., suggest persistent pulmonary dysfunction might significantly affect HRQoL. Strategies like low-tidal-volume ventilation and other supportive measures have improved outcomes, but persistent lung dysfunction remains a challenge. The potential role of early HRCT scanning is discussed as a tool to identify long-term risks, albeit without clear therapeutic interventions currently available.<br /><br />Finally, the article summarizes the "Choosing Wisely" campaign in critical care, which aims to optimize healthcare by reducing unnecessary tests and treatments that do not benefit patients. This initiative was inspired by Dr. Howard Brody's recommendation for professional societies to identify and minimize ineffective medical practices. The Critical Care Societies Collaborative has developed a top-five list of common but often unnecessary medical services to encourage better decision-making, thus improving resource utilization and patient care. The authors emphasize the need for physicians to balance appropriate testing and treatment to avoid wasting healthcare resources and ensure timely diagnoses and interventions.

Keywords

sepsis

atrial fibrillation

CHA2DS2-VASc score

acute respiratory distress syndrome

low-tidal-volume ventilation

health-related quality of life

persistent pulmonary dysfunction

Choosing Wisely campaign

Critical Care Societies Collaborative

healthcare resource optimization