Less sarlimumab, more SAT/SBTs.
A year ago this month, I was fortunate to publish Treading Lightly in a Pandemic: #Zentensivist Reflections on COVID-19, alongside my friends and colleagues Sid Dugar and Kiran Shekar. It’s freely available in the link above.
It isn’t surprising we made it through the pandemic without finding “magic bullets”; the history of critical care medicine research could have taught us the same.
We were far from alone in calling for a focus on evidence-based treatment of ARDS during this pandemic. An excellent, but non-exhaustive list of examples:
- Todd Rice and David Janz in the Blue journal.
- “All That Glitters Isn’t Gold: Critical Care in the Time of Coronavirus Disease 2019”, written by several of my Friends from Online in Chest, including Alice Gallo, Chris Carroll, and Katie Pendleton.
- Finally, “Sensible Medicine” by Chris Seymour, Erin McCreary, and Jacob Stegenga. This work is particularly notable for a great diagram which captures the heart of zentensivism in many ways.
While the pandemic is far from over, the lessons of these publications still stand. We must continue to practice evidence-based principles of respiratory failure, including daily coordinated spontaneous awakening and breathing trials, lung-protective ventilation, prone positioning, and the A2F bundle.
As in the beginning, any new pharmacotherapies need to undergo rigorous investigation in clinical trials. We are fortunate to have gained knowledge from large, well-functioning groups like RECOVERY, amongst others.
In the meanwhile, we must continue to tread lightly through this pandemic.