CHEST Guidelines-Treading-Lightly-in-a-Pandemic_2020

Treading-Lightly-in-a-Pandemic_2020_chest

Pdf Summary

The document is a reflection on the challenges of treating COVID-19 within intensive care units (ICUs) during the pandemic, advocating a zen-like approach to care known as "#zentensivist." This philosophy combines mindfulness with ICU care principles, emphasizing minimally invasive, pragmatic, and humanistic methodologies over aggressive interventions, particularly given the uncertainty and the historical ineffectiveness of many pharmacologic interventions based on bioplausibility.<br /><br />With COVID-19 presenting unique clinical and logistical challenges, there has been a trend towards early mechanical ventilation for hypoxemic respiratory failure, driven by fear of rapid clinical deterioration and limited evidence. The authors criticize this tendency, arguing that it risks iatrogenic harm and resource depletion, recommending that clinicians instead consider high-flow nasal cannula and awake prone positioning, which enable patient participation and reduce the need for mechanical ventilation. This aligns with the zentensivist's minimally invasive philosophy which emphasizes remaining vigilant yet allowing natural recovery.<br /><br />Additionally, the article underscores the necessity of personalized care, taking into account individual patient characteristics such as age and frailty in deciding treatment paths, with anticipation of emerging evidence and interventions. It critiques the clinical community’s susceptibility to adopting unproven, new therapies simply because they appear promising, suggesting reliance instead on well-studied interventions like the ABCDEF bundle, which are known to improve patient outcomes.<br /><br />Ultimately, the document portrays zentensivism as a mindful, patient-centric approach in critical care that promotes the idea that less invasive care could actually benefit a larger number of patients, advocating for a reassessment of care strategies during the pandemic, emphasizing core, time-tested interventions, and the principle of "less is more."

Keywords

COVID-19

ICU

zentensivist

mindfulness

mechanical ventilation

iatrogenic harm

personalized care

ABCDEF bundle

patient-centric

less is more