0
Point/Counterpoint Editorials |

Rebuttal From Dr SesslerRebuttal

Curtis N. Sessler, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System.

Correspondence to: Curtis N. Sessler, MD, FCCP, Division of Pulmonary and Critical Care Medicine, Virginia Commonwealth University Health System, Medical College of Virginia Campus, Box 980050, Richmond, VA 23298; e-mail: csessler@vcu.edu


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2013;144(5):1446-1447. doi:10.1378/chest.13-1463
Text Size: A A A
Published online

Extract

Critical care has entered an era in which a “less is more” therapeutic approach, such as use of low tidal ventilation in ARDS or conservative transfusion practice, is linked to better patient outcomes. Furthermore, preservation of mental and physical activity that mimics a healthy state by avoiding deep sedation and applying early mobilization is now widely embraced. Accordingly, a strategy of routinely applying pharmacologically induced deep sedation and paralysis that violates these basic tenets should be scrutinized before it is embraced. Dr Hall presented arguments in favor of the routine use of paralytic agents in severe ARDS.1 Admittedly, the pivotal placebo-controlled randomized controlled trial (RCT) in severe ARDS by Papazian et al2 yielded impressive findings. Randomization to cisatracurium was associated with more rapid recovery from respiratory failure, absence of attributable neuromuscular disease, and trends for better survival. As in all aspects of patient care, potentially risky management should be limited to patients for whom benefit is most likely.

First Page Preview

View Large
First page PDF preview

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543