Long-term outcomes of patients after acute respiratory distress syndrome: hard work for nothing?

Acute respiratory distress syndrome (ARDS) is a common syndrome that can impose significant health burdens on individuals and the health care systems that serve them. Patients who are treated for this condition in the acute setting often face long-term physical and psychological complications that result from their prolonged hospitalization. While there is reasonable evidence for the use of conventional ventilation strategies, little is known about the effectiveness of unconventional treatment strategies; moreover, the existing literature does not support routine use of these often expensive interventions. It is difficult to prognosticate the long-term function of an individual patient in the acute setting, and thus it is too early to say that some of the unconventional treatments should be abandoned merely because the existing studies do not demonstrate efficacy. This is complicated by the fact that ARDS is a heterogeneous syndrome with a heterogeneous patient population. Experts in ARDS can reasonably continue to use these interventions (with caution, based on their clinical experience) and should continually evaluate their physiologic effect; however, we must keep in mind that there is no clear evidence as to whether these treatments provide benefit or harm and that continuous, rigorous evaluation is required.