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Patients with non-advanced LC. Boxed warning for montelukast. The happy hypoxic. COVID-19 and pulmonary vasculature.
Interventional chest and diagnostic procedures
Impact of COVID-19 pandemic in patients with non-advanced LC
The COVID-19 pandemic has challenged the way we screen for, diagnose, and treat lung cancer.1, 2 Knowing that these patients are at higher risk of respiratory failure, and that COVID-19 causes poor outcomes in cancer patients,1,3,4 valid concerns regarding viral transmission to patients and health-care workers have hampered the expedited care this population needs.
In recent months, efforts to manage the pandemic have been herculean. With the goal of limiting transmission, expert panels have offered guidance including limiting access to medical facilities, decreasing aerosolizing procedures, and prioritizing curative treatments.2,5 In general, lung cancer screening should be delayed, and patients with highly suspicious localized pulmonary lesions could receive empiric regimens, surgery, or stereotactic radiotherapy.1,3-5
The conundrum occurs when diagnostic bronchoscopy is required for staging, acquiring tissue for targeted therapy, or a moderate-risk pulmonary nodule with indeterminate PET-CT and/or high-risk for CT-guided biopsy. Thoughtful balancing of risks and benefits depends on patient comorbidities, hospital resources – such preprocedural COVID screening, adequate protective personal equipment- and rate of local viral prevalence.6,7 Delaying diagnosis and staging could lead to progression of cancer and preclude curative or adjuvant therapy for appropriate candidates. Furthermore, we should not dismiss the appalling psychological impact of delayed care on our patients.
While the pandemic continues and challenges arise in the care of patients with lung cancer, the value of a multidisciplinary input and individualized care cannot be overstated, with focus on providing the best care possible while both minimizing transmission and increasing the chances of acceptable outcomes.
Jose De Cardenas MD, FCCP – Steering Committee Member
Abdul Hamid Alraiyes MD, FCCP – Steering Committee Member
References
1. Mazzone PJ, et al. Chest. 2020;158(1):406-415. doi: 10.1016/j.chest.2020.04.020.
2. Banna G, et al. ESMO Open. 2020;5(2):e000765. doi: 10.1136/esmoopen-2020-000765.
3. Liang W, et al. Lancet Oncol. 2020;21(3):335-337. doi: 10.1016/S1470-2045(20)30096-6.
4. Singh AP, et al. JCO Oncol Pract. 2020 May 26;OP2000286. doi: 10.1200/OP.20.00286.
5. Dingemans AC, et al. J Thorac Oncol. 2020;15(7):1119-1136. doi: 10.1016/j.jtho.2020.05.001.
6. Wahidi MM, et al. J Bronchology Interv Pulmonol. 2020 Mar 18. doi: 10.1097/LBR.0000000000000681.
7. Pritchett MA, et al. J Thorac Dis. 2020;12(5):1781-1798. doi: 10.21037/jtd.2020.04.32.
Pediatric chest medicine
FDA strengthens the boxed warning for montelukast
Early this year the Food and Drug Administration (FDA) updated the boxed warning for montelukast (Singulair), related to the potential for serious mental health side effects, such as agitation, aggressive behavior, depression, hallucinations, and suicidal thoughts and actions. Since its approval in 1998, montelukast is part of the therapeutic approach for persistent asthma in children age 1 year and older, allergic rhinitis from 6 months and older, and exercises induced bronchospasm in children age 6 years and older. In 2018, around 2.3 million children younger than 17 years received a prescription for montelukast.
The FDA reviewed data from their Sentinel System comparing children receiving montelukast vs inhaled corticosteroids, and this study failed to demonstrate significant increased risk of hospitalized depressive disorders, outpatient depressive disorders, self-harm, or suicide. However, a focused evaluation by the FDA of suicides identified 82 cases of completed suicides associated with montelukast, and 19 of these cases were in children younger than 17 years of age.
Post-marketing case reports submitted to the FDA, published observational and animal studies were evaluated along with the Sentinel System study that led to the new recommendations.
Finally, on March 4, 2020, the FDA updated the Singulair®/montelukast black box warning, focusing on the importance of advising patients and caregivers about the potential for serious neuropsychiatric side effects and advice to immediately discontinue use if symptoms occurred. The warning contains a strong recommendation to reserve use of Singulair®/montelukast to patients with allergic rhinitis who have an inadequate response or intolerance to alternate therapies.
Endy Dominguez Silveyra, MD - Fellow-in-Training Member
References
1. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. FDA Drug Safety Communication, March 4, 2020.
2. Neuropsychiatric events following montelukast use: A propensity score matched analysis. Sentinel, Sept. 27, 2019.
Pulmonary physiology, function, and rehabilitation
The happy hypoxic
In early December 2019, the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified. Over the ensuing months, SARS-CoV-2 would cause a wide range of pulmonary symptoms from cough and mild shortness of breath to acute respiratory distress syndrome (ARDS) with severe hypoxia that puzzled intensivists worldwide.
One such mystifying presentation was finding patients with critically low oxygen levels who did not appear to be short of breath. This concept was dubbed “happy or silent hypoxemia.” Novel mechanisms of the SARS-Co-V-2 virus on the respiratory system have been proposed to explain this paradox, but recent literature suggests that foundational pulmonary physiology concepts can explain most of these findings.1
Breathing is centrally controlled by the respiratory center in the brain stem and is influenced mainly by dissolved carbon dioxide and pH.2 Hypercapnia is, therefore, a powerful stimulus to breathe and increase minute ventilation. It can cause dyspnea if this demand is not met.3
Hypoxia, on the other hand, is less powerful and does not evoke dyspnea until the PaO2 drops below 60 mm Hg.4 Hypercapnia potentiates this response: the higher the PaCO2, the higher the hypoxic response. Patients with a PaCO2 of 39 mm Hg or less may not experience dyspnea even when hypoxia is severe.1
Other possible explanations for silent hypoxemia include the poor accuracy of the pulse oximeter for estimating oxygen saturation of less than 80%,1 especially in the critically ill5 and the leftward shift of the oxygen dissociation curve due to fever, making the oxygen saturation lower for any given PaO2.1
In conclusion, the clinical management of COVID-19 pneumonia with a broad range of clinical features presents many unknowns, but it is reassuring to find an anchor in good old pulmonary physiology concepts.5
It is back to the basics for us all and that might be a good thing.
Oriade Adeoye, MD – Fellow-in-Training Member
References
1. Tobin MJ, et al. Am J Respir Crit Care Med. 2020;202(3):356-360. doi: 10.1164/rccm.202006-2157CP.
2. Vaporidi K, et al. Am J Respir Crit Care Med. 2020;201(1):20-32. doi: 10.1164/rccm.201903-0596SO.
3. Dhont S, et al. Respir Res. 2020;21(1):198. doi:10.1186/s12931-020-01462-5.
4. Weil JV, et al. J Clin Invest. 1970;49(6):1061-1072. doi:10.1172/JCI106322.
5. Tobin MJ. Am J Respir Crit Care Med. 2020;201(11):1319-1320. doi:10.1164/rccm.202004-1076ED.
Pulmonary vascular disease
COVID-19 and pulmonary vasculature: an intriguing relationship
Hypoxemia is the cardinal symptom in patients with severe coronavirus disease-2019 (COVID-19). However, hypoxemia disproportionate to radiographic opacities has led to growing suspicion that involvement of pulmonary vasculature (PV), leading to shunt physiology, may be a driver of this marked hypoxemia.
The virus’s affinity for PV is explained by presence of angiotensin-converting enzyme 2 receptor, which serves as the functional receptor for SARS-CoV-2, on pulmonary endothelium (Provencher, et al. Pulm Circ. 2020 Jun 10;10[3]:2045894020933088. doi: 10.1177/2045894020933088).
This increased affinity predisposes PV to pathologic effects of SARS-CoV-2, noted in COVID-19 patients’ autopsies, which revealed pulmonary endothelial injury and abnormal vessel growth (intussusceptive angiogenesis). These changes, along with profound inflammatory response, further predispose the PV to thrombosis and microangiopathy in COVID-19 (Ackermann, et al. N Engl J Med. 2020 Jul 9;383[2]:120-128).
These autopsy results also explain the radiologic findings of PV in COVID-19. Dual energy CT scanning, used to evaluate lung perfusion in these patients, has demonstrated PV thickening, mosaicism, and pulmonary vessel dilation; the latter likely occurring due to aberrations in physiologic hypoxic pulmonary vasoconstriction (Lang, et al. Lancet. 2020 Apr 30;S1473-3099[20]30367).
Despite PV’s involvement, only few cases of COVID-19 have been reported in patients with pulmonary arterial hypertension (PAH) , leading to the hypothesis that pre-existing vascular changes may have a protective effect in PAH patients (Horn, et al. Pulm Circ. 2020;10(2):1-2).
The above discussion details the complex and multifaceted relationship between COVID-19 and PV which underscores the value of understanding this interaction further and may prove to be insightful for discovering potential therapeutic targets in COVID-19.
Humna Abid Memon, MD – Fellow-in-Training Member
Interventional chest and diagnostic procedures
Impact of COVID-19 pandemic in patients with non-advanced LC
The COVID-19 pandemic has challenged the way we screen for, diagnose, and treat lung cancer.1, 2 Knowing that these patients are at higher risk of respiratory failure, and that COVID-19 causes poor outcomes in cancer patients,1,3,4 valid concerns regarding viral transmission to patients and health-care workers have hampered the expedited care this population needs.
In recent months, efforts to manage the pandemic have been herculean. With the goal of limiting transmission, expert panels have offered guidance including limiting access to medical facilities, decreasing aerosolizing procedures, and prioritizing curative treatments.2,5 In general, lung cancer screening should be delayed, and patients with highly suspicious localized pulmonary lesions could receive empiric regimens, surgery, or stereotactic radiotherapy.1,3-5
The conundrum occurs when diagnostic bronchoscopy is required for staging, acquiring tissue for targeted therapy, or a moderate-risk pulmonary nodule with indeterminate PET-CT and/or high-risk for CT-guided biopsy. Thoughtful balancing of risks and benefits depends on patient comorbidities, hospital resources – such preprocedural COVID screening, adequate protective personal equipment- and rate of local viral prevalence.6,7 Delaying diagnosis and staging could lead to progression of cancer and preclude curative or adjuvant therapy for appropriate candidates. Furthermore, we should not dismiss the appalling psychological impact of delayed care on our patients.
While the pandemic continues and challenges arise in the care of patients with lung cancer, the value of a multidisciplinary input and individualized care cannot be overstated, with focus on providing the best care possible while both minimizing transmission and increasing the chances of acceptable outcomes.
Jose De Cardenas MD, FCCP – Steering Committee Member
Abdul Hamid Alraiyes MD, FCCP – Steering Committee Member
References
1. Mazzone PJ, et al. Chest. 2020;158(1):406-415. doi: 10.1016/j.chest.2020.04.020.
2. Banna G, et al. ESMO Open. 2020;5(2):e000765. doi: 10.1136/esmoopen-2020-000765.
3. Liang W, et al. Lancet Oncol. 2020;21(3):335-337. doi: 10.1016/S1470-2045(20)30096-6.
4. Singh AP, et al. JCO Oncol Pract. 2020 May 26;OP2000286. doi: 10.1200/OP.20.00286.
5. Dingemans AC, et al. J Thorac Oncol. 2020;15(7):1119-1136. doi: 10.1016/j.jtho.2020.05.001.
6. Wahidi MM, et al. J Bronchology Interv Pulmonol. 2020 Mar 18. doi: 10.1097/LBR.0000000000000681.
7. Pritchett MA, et al. J Thorac Dis. 2020;12(5):1781-1798. doi: 10.21037/jtd.2020.04.32.
Pediatric chest medicine
FDA strengthens the boxed warning for montelukast
Early this year the Food and Drug Administration (FDA) updated the boxed warning for montelukast (Singulair), related to the potential for serious mental health side effects, such as agitation, aggressive behavior, depression, hallucinations, and suicidal thoughts and actions. Since its approval in 1998, montelukast is part of the therapeutic approach for persistent asthma in children age 1 year and older, allergic rhinitis from 6 months and older, and exercises induced bronchospasm in children age 6 years and older. In 2018, around 2.3 million children younger than 17 years received a prescription for montelukast.
The FDA reviewed data from their Sentinel System comparing children receiving montelukast vs inhaled corticosteroids, and this study failed to demonstrate significant increased risk of hospitalized depressive disorders, outpatient depressive disorders, self-harm, or suicide. However, a focused evaluation by the FDA of suicides identified 82 cases of completed suicides associated with montelukast, and 19 of these cases were in children younger than 17 years of age.
Post-marketing case reports submitted to the FDA, published observational and animal studies were evaluated along with the Sentinel System study that led to the new recommendations.
Finally, on March 4, 2020, the FDA updated the Singulair®/montelukast black box warning, focusing on the importance of advising patients and caregivers about the potential for serious neuropsychiatric side effects and advice to immediately discontinue use if symptoms occurred. The warning contains a strong recommendation to reserve use of Singulair®/montelukast to patients with allergic rhinitis who have an inadequate response or intolerance to alternate therapies.
Endy Dominguez Silveyra, MD - Fellow-in-Training Member
References
1. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. FDA Drug Safety Communication, March 4, 2020.
2. Neuropsychiatric events following montelukast use: A propensity score matched analysis. Sentinel, Sept. 27, 2019.
Pulmonary physiology, function, and rehabilitation
The happy hypoxic
In early December 2019, the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified. Over the ensuing months, SARS-CoV-2 would cause a wide range of pulmonary symptoms from cough and mild shortness of breath to acute respiratory distress syndrome (ARDS) with severe hypoxia that puzzled intensivists worldwide.
One such mystifying presentation was finding patients with critically low oxygen levels who did not appear to be short of breath. This concept was dubbed “happy or silent hypoxemia.” Novel mechanisms of the SARS-Co-V-2 virus on the respiratory system have been proposed to explain this paradox, but recent literature suggests that foundational pulmonary physiology concepts can explain most of these findings.1
Breathing is centrally controlled by the respiratory center in the brain stem and is influenced mainly by dissolved carbon dioxide and pH.2 Hypercapnia is, therefore, a powerful stimulus to breathe and increase minute ventilation. It can cause dyspnea if this demand is not met.3
Hypoxia, on the other hand, is less powerful and does not evoke dyspnea until the PaO2 drops below 60 mm Hg.4 Hypercapnia potentiates this response: the higher the PaCO2, the higher the hypoxic response. Patients with a PaCO2 of 39 mm Hg or less may not experience dyspnea even when hypoxia is severe.1
Other possible explanations for silent hypoxemia include the poor accuracy of the pulse oximeter for estimating oxygen saturation of less than 80%,1 especially in the critically ill5 and the leftward shift of the oxygen dissociation curve due to fever, making the oxygen saturation lower for any given PaO2.1
In conclusion, the clinical management of COVID-19 pneumonia with a broad range of clinical features presents many unknowns, but it is reassuring to find an anchor in good old pulmonary physiology concepts.5
It is back to the basics for us all and that might be a good thing.
Oriade Adeoye, MD – Fellow-in-Training Member
References
1. Tobin MJ, et al. Am J Respir Crit Care Med. 2020;202(3):356-360. doi: 10.1164/rccm.202006-2157CP.
2. Vaporidi K, et al. Am J Respir Crit Care Med. 2020;201(1):20-32. doi: 10.1164/rccm.201903-0596SO.
3. Dhont S, et al. Respir Res. 2020;21(1):198. doi:10.1186/s12931-020-01462-5.
4. Weil JV, et al. J Clin Invest. 1970;49(6):1061-1072. doi:10.1172/JCI106322.
5. Tobin MJ. Am J Respir Crit Care Med. 2020;201(11):1319-1320. doi:10.1164/rccm.202004-1076ED.
Pulmonary vascular disease
COVID-19 and pulmonary vasculature: an intriguing relationship
Hypoxemia is the cardinal symptom in patients with severe coronavirus disease-2019 (COVID-19). However, hypoxemia disproportionate to radiographic opacities has led to growing suspicion that involvement of pulmonary vasculature (PV), leading to shunt physiology, may be a driver of this marked hypoxemia.
The virus’s affinity for PV is explained by presence of angiotensin-converting enzyme 2 receptor, which serves as the functional receptor for SARS-CoV-2, on pulmonary endothelium (Provencher, et al. Pulm Circ. 2020 Jun 10;10[3]:2045894020933088. doi: 10.1177/2045894020933088).
This increased affinity predisposes PV to pathologic effects of SARS-CoV-2, noted in COVID-19 patients’ autopsies, which revealed pulmonary endothelial injury and abnormal vessel growth (intussusceptive angiogenesis). These changes, along with profound inflammatory response, further predispose the PV to thrombosis and microangiopathy in COVID-19 (Ackermann, et al. N Engl J Med. 2020 Jul 9;383[2]:120-128).
These autopsy results also explain the radiologic findings of PV in COVID-19. Dual energy CT scanning, used to evaluate lung perfusion in these patients, has demonstrated PV thickening, mosaicism, and pulmonary vessel dilation; the latter likely occurring due to aberrations in physiologic hypoxic pulmonary vasoconstriction (Lang, et al. Lancet. 2020 Apr 30;S1473-3099[20]30367).
Despite PV’s involvement, only few cases of COVID-19 have been reported in patients with pulmonary arterial hypertension (PAH) , leading to the hypothesis that pre-existing vascular changes may have a protective effect in PAH patients (Horn, et al. Pulm Circ. 2020;10(2):1-2).
The above discussion details the complex and multifaceted relationship between COVID-19 and PV which underscores the value of understanding this interaction further and may prove to be insightful for discovering potential therapeutic targets in COVID-19.
Humna Abid Memon, MD – Fellow-in-Training Member
Interventional chest and diagnostic procedures
Impact of COVID-19 pandemic in patients with non-advanced LC
The COVID-19 pandemic has challenged the way we screen for, diagnose, and treat lung cancer.1, 2 Knowing that these patients are at higher risk of respiratory failure, and that COVID-19 causes poor outcomes in cancer patients,1,3,4 valid concerns regarding viral transmission to patients and health-care workers have hampered the expedited care this population needs.
In recent months, efforts to manage the pandemic have been herculean. With the goal of limiting transmission, expert panels have offered guidance including limiting access to medical facilities, decreasing aerosolizing procedures, and prioritizing curative treatments.2,5 In general, lung cancer screening should be delayed, and patients with highly suspicious localized pulmonary lesions could receive empiric regimens, surgery, or stereotactic radiotherapy.1,3-5
The conundrum occurs when diagnostic bronchoscopy is required for staging, acquiring tissue for targeted therapy, or a moderate-risk pulmonary nodule with indeterminate PET-CT and/or high-risk for CT-guided biopsy. Thoughtful balancing of risks and benefits depends on patient comorbidities, hospital resources – such preprocedural COVID screening, adequate protective personal equipment- and rate of local viral prevalence.6,7 Delaying diagnosis and staging could lead to progression of cancer and preclude curative or adjuvant therapy for appropriate candidates. Furthermore, we should not dismiss the appalling psychological impact of delayed care on our patients.
While the pandemic continues and challenges arise in the care of patients with lung cancer, the value of a multidisciplinary input and individualized care cannot be overstated, with focus on providing the best care possible while both minimizing transmission and increasing the chances of acceptable outcomes.
Jose De Cardenas MD, FCCP – Steering Committee Member
Abdul Hamid Alraiyes MD, FCCP – Steering Committee Member
References
1. Mazzone PJ, et al. Chest. 2020;158(1):406-415. doi: 10.1016/j.chest.2020.04.020.
2. Banna G, et al. ESMO Open. 2020;5(2):e000765. doi: 10.1136/esmoopen-2020-000765.
3. Liang W, et al. Lancet Oncol. 2020;21(3):335-337. doi: 10.1016/S1470-2045(20)30096-6.
4. Singh AP, et al. JCO Oncol Pract. 2020 May 26;OP2000286. doi: 10.1200/OP.20.00286.
5. Dingemans AC, et al. J Thorac Oncol. 2020;15(7):1119-1136. doi: 10.1016/j.jtho.2020.05.001.
6. Wahidi MM, et al. J Bronchology Interv Pulmonol. 2020 Mar 18. doi: 10.1097/LBR.0000000000000681.
7. Pritchett MA, et al. J Thorac Dis. 2020;12(5):1781-1798. doi: 10.21037/jtd.2020.04.32.
Pediatric chest medicine
FDA strengthens the boxed warning for montelukast
Early this year the Food and Drug Administration (FDA) updated the boxed warning for montelukast (Singulair), related to the potential for serious mental health side effects, such as agitation, aggressive behavior, depression, hallucinations, and suicidal thoughts and actions. Since its approval in 1998, montelukast is part of the therapeutic approach for persistent asthma in children age 1 year and older, allergic rhinitis from 6 months and older, and exercises induced bronchospasm in children age 6 years and older. In 2018, around 2.3 million children younger than 17 years received a prescription for montelukast.
The FDA reviewed data from their Sentinel System comparing children receiving montelukast vs inhaled corticosteroids, and this study failed to demonstrate significant increased risk of hospitalized depressive disorders, outpatient depressive disorders, self-harm, or suicide. However, a focused evaluation by the FDA of suicides identified 82 cases of completed suicides associated with montelukast, and 19 of these cases were in children younger than 17 years of age.
Post-marketing case reports submitted to the FDA, published observational and animal studies were evaluated along with the Sentinel System study that led to the new recommendations.
Finally, on March 4, 2020, the FDA updated the Singulair®/montelukast black box warning, focusing on the importance of advising patients and caregivers about the potential for serious neuropsychiatric side effects and advice to immediately discontinue use if symptoms occurred. The warning contains a strong recommendation to reserve use of Singulair®/montelukast to patients with allergic rhinitis who have an inadequate response or intolerance to alternate therapies.
Endy Dominguez Silveyra, MD - Fellow-in-Training Member
References
1. FDA requires boxed warning about serious mental health side effects for asthma and allergy drug montelukast (Singulair); advises restricting use for allergic rhinitis. FDA Drug Safety Communication, March 4, 2020.
2. Neuropsychiatric events following montelukast use: A propensity score matched analysis. Sentinel, Sept. 27, 2019.
Pulmonary physiology, function, and rehabilitation
The happy hypoxic
In early December 2019, the novel coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was identified. Over the ensuing months, SARS-CoV-2 would cause a wide range of pulmonary symptoms from cough and mild shortness of breath to acute respiratory distress syndrome (ARDS) with severe hypoxia that puzzled intensivists worldwide.
One such mystifying presentation was finding patients with critically low oxygen levels who did not appear to be short of breath. This concept was dubbed “happy or silent hypoxemia.” Novel mechanisms of the SARS-Co-V-2 virus on the respiratory system have been proposed to explain this paradox, but recent literature suggests that foundational pulmonary physiology concepts can explain most of these findings.1
Breathing is centrally controlled by the respiratory center in the brain stem and is influenced mainly by dissolved carbon dioxide and pH.2 Hypercapnia is, therefore, a powerful stimulus to breathe and increase minute ventilation. It can cause dyspnea if this demand is not met.3
Hypoxia, on the other hand, is less powerful and does not evoke dyspnea until the PaO2 drops below 60 mm Hg.4 Hypercapnia potentiates this response: the higher the PaCO2, the higher the hypoxic response. Patients with a PaCO2 of 39 mm Hg or less may not experience dyspnea even when hypoxia is severe.1
Other possible explanations for silent hypoxemia include the poor accuracy of the pulse oximeter for estimating oxygen saturation of less than 80%,1 especially in the critically ill5 and the leftward shift of the oxygen dissociation curve due to fever, making the oxygen saturation lower for any given PaO2.1
In conclusion, the clinical management of COVID-19 pneumonia with a broad range of clinical features presents many unknowns, but it is reassuring to find an anchor in good old pulmonary physiology concepts.5
It is back to the basics for us all and that might be a good thing.
Oriade Adeoye, MD – Fellow-in-Training Member
References
1. Tobin MJ, et al. Am J Respir Crit Care Med. 2020;202(3):356-360. doi: 10.1164/rccm.202006-2157CP.
2. Vaporidi K, et al. Am J Respir Crit Care Med. 2020;201(1):20-32. doi: 10.1164/rccm.201903-0596SO.
3. Dhont S, et al. Respir Res. 2020;21(1):198. doi:10.1186/s12931-020-01462-5.
4. Weil JV, et al. J Clin Invest. 1970;49(6):1061-1072. doi:10.1172/JCI106322.
5. Tobin MJ. Am J Respir Crit Care Med. 2020;201(11):1319-1320. doi:10.1164/rccm.202004-1076ED.
Pulmonary vascular disease
COVID-19 and pulmonary vasculature: an intriguing relationship
Hypoxemia is the cardinal symptom in patients with severe coronavirus disease-2019 (COVID-19). However, hypoxemia disproportionate to radiographic opacities has led to growing suspicion that involvement of pulmonary vasculature (PV), leading to shunt physiology, may be a driver of this marked hypoxemia.
The virus’s affinity for PV is explained by presence of angiotensin-converting enzyme 2 receptor, which serves as the functional receptor for SARS-CoV-2, on pulmonary endothelium (Provencher, et al. Pulm Circ. 2020 Jun 10;10[3]:2045894020933088. doi: 10.1177/2045894020933088).
This increased affinity predisposes PV to pathologic effects of SARS-CoV-2, noted in COVID-19 patients’ autopsies, which revealed pulmonary endothelial injury and abnormal vessel growth (intussusceptive angiogenesis). These changes, along with profound inflammatory response, further predispose the PV to thrombosis and microangiopathy in COVID-19 (Ackermann, et al. N Engl J Med. 2020 Jul 9;383[2]:120-128).
These autopsy results also explain the radiologic findings of PV in COVID-19. Dual energy CT scanning, used to evaluate lung perfusion in these patients, has demonstrated PV thickening, mosaicism, and pulmonary vessel dilation; the latter likely occurring due to aberrations in physiologic hypoxic pulmonary vasoconstriction (Lang, et al. Lancet. 2020 Apr 30;S1473-3099[20]30367).
Despite PV’s involvement, only few cases of COVID-19 have been reported in patients with pulmonary arterial hypertension (PAH) , leading to the hypothesis that pre-existing vascular changes may have a protective effect in PAH patients (Horn, et al. Pulm Circ. 2020;10(2):1-2).
The above discussion details the complex and multifaceted relationship between COVID-19 and PV which underscores the value of understanding this interaction further and may prove to be insightful for discovering potential therapeutic targets in COVID-19.
Humna Abid Memon, MD – Fellow-in-Training Member
CHEST 2020 is coming to YOU
Expert-driven education—reimagined
CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.
This year, you can expect:
• A keynote address by Anthony Fauci, MD, covering COVID-19.
• Over 88 live sessions, including panel and case-based discussions.
• Critically relevant sessions focusing on COVID-19 and cultural diversity.
• Original investigation presentations with new, unpublished science.
• Unique networking opportunities.
• Fun and interactive CHEST Games.
Register Today
Chestmeeting.chestnet.org
Expert-driven education—reimagined
Expert-driven education—reimagined
CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.
This year, you can expect:
• A keynote address by Anthony Fauci, MD, covering COVID-19.
• Over 88 live sessions, including panel and case-based discussions.
• Critically relevant sessions focusing on COVID-19 and cultural diversity.
• Original investigation presentations with new, unpublished science.
• Unique networking opportunities.
• Fun and interactive CHEST Games.
Register Today
Chestmeeting.chestnet.org
CHEST’s premier event in pulmonary, critical care, and sleep medicine is just around the corner! Join us for CHEST Annual Meeting 2020, taking place October 18-21. We know it’s hard to plan out your schedule during an ever-changing pandemic, which is why this year’s meeting is being brought to you on a virtual platform. You’ll be able to access the meeting content from any device, in any location, at any time. It’s that convenient! Plus, you can join in immersive, interactive live sessions taught by expert faculty and followed by Q&As, or listen to prerecorded content at your own pace. Don’t worry if you’re unable to attend a session — all meeting content will be available to registrants until January 2021.
This year, you can expect:
• A keynote address by Anthony Fauci, MD, covering COVID-19.
• Over 88 live sessions, including panel and case-based discussions.
• Critically relevant sessions focusing on COVID-19 and cultural diversity.
• Original investigation presentations with new, unpublished science.
• Unique networking opportunities.
• Fun and interactive CHEST Games.
Register Today
Chestmeeting.chestnet.org
This month in the journal CHEST®
Editor’s picks
Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.
Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.
Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.
Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.
Editor’s picks
Editor’s picks
Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.
Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.
Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.
Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.
Individualizing risk prediction for positive COVID-19 testing: results from 11,672 patients. By Dr. Lara Jehi, et al.
Airway clearance techniques in bronchiectasis: Analysis from the United States Bronchiectasis and NTM research registry. By Dr. Ashwin Basavaraj, et al.
Emotional experiences and coping strategies of family members of critically ill patients. By Dr. Emily Harlan, et al.
Coronavirus disease and smoking: How and why we implemented a tobacco treatment campaign. By Dr. Adam Lang, et al.
Connect with the CHEST Foundation at CHEST 2020
Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
Virtual Champion’s Circle Donor Lounge
The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT
Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT
Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!
Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST
Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only
Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!
Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
Virtual Champion’s Circle Donor Lounge
The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT
Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT
Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!
Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST
Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only
Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!
Join the CHEST Foundation at one of its many virtual events designed around the three pillars of the organization—access, empowerment, and research—during CHEST 2020. Please check CHESTMeeting.chestnet.org for more details on each event.
Virtual Champion’s Circle Donor Lounge
The virtual donor lounge will act as the hub of a wheel – linking the spokes of Foundation programming and events to a central location for easy accessibility. Foundation staff and Board of Trustee members will staff the donor lounge throughout the meeting.
Women & Pulmonary Event – Sunday, October 18 at 11:00 AM – 12:30 PM CT
Connect with key thought leaders and participants to support the advancement of women in the fields of pulmonary, critical care, sleep medicine, and in leadership. The event includes a panel discussion on How to remain in control during a pandemic: family, career and mental wellness, followed by an intimate roundtable discussion moderated by the Women & Pulmonary council. RSVPs are necessary to attend this event.
CHEST Foundation Donor Reception– Sunday, October 18 7:30 PM CT
Join your colleagues and CHEST leadership for a night of fun and networking. Learn to play Texas Hold’em in a complimentary, casual poker tournament and join the high stakes tournament later this month!
Wine Night with CEO Bob Musacchio – Invite Only – Sunday, October 18 7:30 CST
Join CHEST’s CEO, Bob Musacchio for an interactive, exclusive wine night. The evening will include wine chosen from Bob’s personal favorites and kick off the CHEST 2020 annual meeting as we have never done before!
Young Professionals Reception – Monday, October 19, 2020 at 8:00 PM CT – Invite Only
Join your colleagues for a fun evening of trivia, prizes, and celebration! Let the Foundation show some appreciation for your commitment to chest medicine and come learn more about our work!
Sustaining high performance during the COVID-19 pandemic: Time for a paradigm shift?
Last week, I was working in our COVID ICU. Today, I had a day to catch up, and sat down at my desk to start answering patient phone calls and work on my overflowing e-mail inbox. On the top was a message reminding me that my mandatory online training requirements are overdue.
Many of my overdue tasks date back to somewhere between early March and mid-May, at a time when the United States was feeling the first real effects of the global COVID-19 pandemic. The radical disruption to our personal and professional lives was palpable. As physicians practicing chest medicine, we and our interprofessional teams faced the unknown every day as we cared for patients suffering from an illness we had never seen. Change was everywhere, and keeping up with new policy, practice protocols, and the reports and speculation that emanated from every corner of our society became an impossible proposition. We tried, though, because our patients and hospitals needed us – because people were dying. As physicians, we felt our moral responsibility to care for our patients to the best of our ability, and to keep ourselves and our team members – not to mention our family – safe and healthy.
Since that time, life has remained far from normal, but oddly a new routine has started to emerge. I’m getting used to wearing a mask outside of my house, and my skills with virtual meeting software have increased exponentially. As the months passed, my social media feed started to display images of families taking summer vacations – often in areas of the United States known for its wide open spaces – while riots over racial inequality raged in our major cities, and a second wave of COVID-19 cases hit many states across our country.
As highly trained professionals engaged on the front line of this pandemic, we have faced the challenges of COVID-19 with hard work and innovation. The countless extra hours have paid off, and what appeared to be a bizarre dichotomy, my social media feed I think reflected a real and appropriate need for us to take time to recover from the stresses of the spring and summer. Now fall is upon us, and with it the threat of another wave of new COVID cases. There is much more work that needs to be done.
Highly trained athletes understand the importance of a deliberate approach to their daily activities. A balance between stress and recovery is necessary to both sustain high performance and avoid injuries from overuse. Similarly, chronic excessive demands without adequate time to recover can create a state psychologists call “nonfunctional overreaching” – a short term reduction in performance that only returns to normal after a period of sustained rest. Although most of this work has been done in the sports psychology literature, it does not take a vivid imagination to extend these concepts into the health-care environment. As time goes on, we won’t be able to deliver the best care we can to our patients or family unless we take time to take care of ourselves.
In July, CHEST launched a new initiative to offer our members a series of monthly webinars to discuss the science of sustaining high performance and practical approaches to support individual, team, and organizational wellness during these challenging times. We have recruited nationally recognized experts from both within and outside of our subspecialty for this initiative and have partnered with the American Association of Critical-Care Nurses, the American Association for Respiratory Care, and The National Board for Respiratory Care to support all members of our interprofessional team.
Our efforts over the first 6 months of this initiative are focused on the science of high performance, including the latest tips for sleep, nutrition, and exercise, and are available in the new CHEST Wellness Resource Center to help you recover at the end of an exhausting day at work and help keep you at your best for tomorrow. Recognizing the tremendous toll that the first wave of the pandemic took on many members of our community, we have also identified resources to help recognize and provide timely assistance to those who need it the most. Our initiative also includes opportunities to express gratitude to our nursing and respiratory therapy colleagues for the sacrifices they make every day and to celebrate the things that put a smile on our faces and make the work day a little easier.
Physicians are resilient people, instilled through their training and the nature of their practice every day – but they are still people. The epidemic of burnout among health-care providers was well documented prior to the current pandemic, and without intervention, the ongoing pandemic will only increase the risk of deteriorating performance, errors, and injury to ourselves and members of our health-care team. It is important to emphasize that this wellness initiative is only the first step in our journey. Our health-care system was far from perfect before this pandemic, and with this challenge comes an opportunity for a paradigm shift – a chance for us to shape our practice environment in new and innovative ways to better serve our patients and support the teams who care for them. Our talented community of CHEST members are the individuals best suited to drive these practice improvements, both now and in the future. To do this effectively in this unprecedented time, however, is going to require members of our discipline to be more deliberate than ever in their approach to caring for themselves, their families, and their health-care teams as part of their everyday practice ... because those e-mails are not going to take care of themselves, and neither are the patients who will continue to turn to us for help in the months and years to come.
I would like to acknowledge and thank Dr. Steve Simpson and Dr. Tim Murgu for their thoughtful feedback and contributions to this article.
Last week, I was working in our COVID ICU. Today, I had a day to catch up, and sat down at my desk to start answering patient phone calls and work on my overflowing e-mail inbox. On the top was a message reminding me that my mandatory online training requirements are overdue.
Many of my overdue tasks date back to somewhere between early March and mid-May, at a time when the United States was feeling the first real effects of the global COVID-19 pandemic. The radical disruption to our personal and professional lives was palpable. As physicians practicing chest medicine, we and our interprofessional teams faced the unknown every day as we cared for patients suffering from an illness we had never seen. Change was everywhere, and keeping up with new policy, practice protocols, and the reports and speculation that emanated from every corner of our society became an impossible proposition. We tried, though, because our patients and hospitals needed us – because people were dying. As physicians, we felt our moral responsibility to care for our patients to the best of our ability, and to keep ourselves and our team members – not to mention our family – safe and healthy.
Since that time, life has remained far from normal, but oddly a new routine has started to emerge. I’m getting used to wearing a mask outside of my house, and my skills with virtual meeting software have increased exponentially. As the months passed, my social media feed started to display images of families taking summer vacations – often in areas of the United States known for its wide open spaces – while riots over racial inequality raged in our major cities, and a second wave of COVID-19 cases hit many states across our country.
As highly trained professionals engaged on the front line of this pandemic, we have faced the challenges of COVID-19 with hard work and innovation. The countless extra hours have paid off, and what appeared to be a bizarre dichotomy, my social media feed I think reflected a real and appropriate need for us to take time to recover from the stresses of the spring and summer. Now fall is upon us, and with it the threat of another wave of new COVID cases. There is much more work that needs to be done.
Highly trained athletes understand the importance of a deliberate approach to their daily activities. A balance between stress and recovery is necessary to both sustain high performance and avoid injuries from overuse. Similarly, chronic excessive demands without adequate time to recover can create a state psychologists call “nonfunctional overreaching” – a short term reduction in performance that only returns to normal after a period of sustained rest. Although most of this work has been done in the sports psychology literature, it does not take a vivid imagination to extend these concepts into the health-care environment. As time goes on, we won’t be able to deliver the best care we can to our patients or family unless we take time to take care of ourselves.
In July, CHEST launched a new initiative to offer our members a series of monthly webinars to discuss the science of sustaining high performance and practical approaches to support individual, team, and organizational wellness during these challenging times. We have recruited nationally recognized experts from both within and outside of our subspecialty for this initiative and have partnered with the American Association of Critical-Care Nurses, the American Association for Respiratory Care, and The National Board for Respiratory Care to support all members of our interprofessional team.
Our efforts over the first 6 months of this initiative are focused on the science of high performance, including the latest tips for sleep, nutrition, and exercise, and are available in the new CHEST Wellness Resource Center to help you recover at the end of an exhausting day at work and help keep you at your best for tomorrow. Recognizing the tremendous toll that the first wave of the pandemic took on many members of our community, we have also identified resources to help recognize and provide timely assistance to those who need it the most. Our initiative also includes opportunities to express gratitude to our nursing and respiratory therapy colleagues for the sacrifices they make every day and to celebrate the things that put a smile on our faces and make the work day a little easier.
Physicians are resilient people, instilled through their training and the nature of their practice every day – but they are still people. The epidemic of burnout among health-care providers was well documented prior to the current pandemic, and without intervention, the ongoing pandemic will only increase the risk of deteriorating performance, errors, and injury to ourselves and members of our health-care team. It is important to emphasize that this wellness initiative is only the first step in our journey. Our health-care system was far from perfect before this pandemic, and with this challenge comes an opportunity for a paradigm shift – a chance for us to shape our practice environment in new and innovative ways to better serve our patients and support the teams who care for them. Our talented community of CHEST members are the individuals best suited to drive these practice improvements, both now and in the future. To do this effectively in this unprecedented time, however, is going to require members of our discipline to be more deliberate than ever in their approach to caring for themselves, their families, and their health-care teams as part of their everyday practice ... because those e-mails are not going to take care of themselves, and neither are the patients who will continue to turn to us for help in the months and years to come.
I would like to acknowledge and thank Dr. Steve Simpson and Dr. Tim Murgu for their thoughtful feedback and contributions to this article.
Last week, I was working in our COVID ICU. Today, I had a day to catch up, and sat down at my desk to start answering patient phone calls and work on my overflowing e-mail inbox. On the top was a message reminding me that my mandatory online training requirements are overdue.
Many of my overdue tasks date back to somewhere between early March and mid-May, at a time when the United States was feeling the first real effects of the global COVID-19 pandemic. The radical disruption to our personal and professional lives was palpable. As physicians practicing chest medicine, we and our interprofessional teams faced the unknown every day as we cared for patients suffering from an illness we had never seen. Change was everywhere, and keeping up with new policy, practice protocols, and the reports and speculation that emanated from every corner of our society became an impossible proposition. We tried, though, because our patients and hospitals needed us – because people were dying. As physicians, we felt our moral responsibility to care for our patients to the best of our ability, and to keep ourselves and our team members – not to mention our family – safe and healthy.
Since that time, life has remained far from normal, but oddly a new routine has started to emerge. I’m getting used to wearing a mask outside of my house, and my skills with virtual meeting software have increased exponentially. As the months passed, my social media feed started to display images of families taking summer vacations – often in areas of the United States known for its wide open spaces – while riots over racial inequality raged in our major cities, and a second wave of COVID-19 cases hit many states across our country.
As highly trained professionals engaged on the front line of this pandemic, we have faced the challenges of COVID-19 with hard work and innovation. The countless extra hours have paid off, and what appeared to be a bizarre dichotomy, my social media feed I think reflected a real and appropriate need for us to take time to recover from the stresses of the spring and summer. Now fall is upon us, and with it the threat of another wave of new COVID cases. There is much more work that needs to be done.
Highly trained athletes understand the importance of a deliberate approach to their daily activities. A balance between stress and recovery is necessary to both sustain high performance and avoid injuries from overuse. Similarly, chronic excessive demands without adequate time to recover can create a state psychologists call “nonfunctional overreaching” – a short term reduction in performance that only returns to normal after a period of sustained rest. Although most of this work has been done in the sports psychology literature, it does not take a vivid imagination to extend these concepts into the health-care environment. As time goes on, we won’t be able to deliver the best care we can to our patients or family unless we take time to take care of ourselves.
In July, CHEST launched a new initiative to offer our members a series of monthly webinars to discuss the science of sustaining high performance and practical approaches to support individual, team, and organizational wellness during these challenging times. We have recruited nationally recognized experts from both within and outside of our subspecialty for this initiative and have partnered with the American Association of Critical-Care Nurses, the American Association for Respiratory Care, and The National Board for Respiratory Care to support all members of our interprofessional team.
Our efforts over the first 6 months of this initiative are focused on the science of high performance, including the latest tips for sleep, nutrition, and exercise, and are available in the new CHEST Wellness Resource Center to help you recover at the end of an exhausting day at work and help keep you at your best for tomorrow. Recognizing the tremendous toll that the first wave of the pandemic took on many members of our community, we have also identified resources to help recognize and provide timely assistance to those who need it the most. Our initiative also includes opportunities to express gratitude to our nursing and respiratory therapy colleagues for the sacrifices they make every day and to celebrate the things that put a smile on our faces and make the work day a little easier.
Physicians are resilient people, instilled through their training and the nature of their practice every day – but they are still people. The epidemic of burnout among health-care providers was well documented prior to the current pandemic, and without intervention, the ongoing pandemic will only increase the risk of deteriorating performance, errors, and injury to ourselves and members of our health-care team. It is important to emphasize that this wellness initiative is only the first step in our journey. Our health-care system was far from perfect before this pandemic, and with this challenge comes an opportunity for a paradigm shift – a chance for us to shape our practice environment in new and innovative ways to better serve our patients and support the teams who care for them. Our talented community of CHEST members are the individuals best suited to drive these practice improvements, both now and in the future. To do this effectively in this unprecedented time, however, is going to require members of our discipline to be more deliberate than ever in their approach to caring for themselves, their families, and their health-care teams as part of their everyday practice ... because those e-mails are not going to take care of themselves, and neither are the patients who will continue to turn to us for help in the months and years to come.
I would like to acknowledge and thank Dr. Steve Simpson and Dr. Tim Murgu for their thoughtful feedback and contributions to this article.
This month in the journal CHEST®
Editor’s picks
The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.
Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.
Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.
Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.
Editor’s picks
Editor’s picks
The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.
Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.
Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.
Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.
The burden of community-acquired pneumonia requiring admission to an intensive care unit in the United States.By Dr. R. Cavallazzi, et al.
Practical considerations for the diagnosis and treatment of fibrotic interstitial lung disease during the COVID-19 pandemic. By Dr. C. J. Ryerson, et al.
Pulmonary hypertension by the method of Paul Wood. By Dr. J. Newman.
Patient vs clinician perspectives on communication about results of lung cancer screening: A Qualitative Study. By Dr. R. Wiener, et al.
The Use of Bronchoscopy During the COVID-19 Pandemic: CHEST/AABIP Guideline and Expert Panel Report. By Dr. M. Wahidi, et al.
Occupations at risk for COVID-19. Palliative care and critical care mutualism. Safer mechanical ventilation. Treatment-emergent central apnea. Lung cancer outcomes improve.
Occupational and environmental health
Occupations at risk for COVID-19
As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.
Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.
Mary Beth Scholand, MD, FCCP – Vice-Chair
Jun She, MD, PhD – Steering Committee Member
Palliative and end-of-life care
Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic
The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”
Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:
- Encouraging values assessment and goals of care for alignment of treatment plans.
- Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
- Facilitating multidisciplinary video family meetings and clinical updates.
- Supporting ICU staff to alleviate moral distress and fatigue.
- Developing and distributing bereavement programs and remembrance rituals.
- Training and education on COVID-specific communication tools.
- Expanding outreach to patients/families through telehealth volunteer programs.
This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).
Tara Coles, MD
Hunter Groninger, MD, Vice Chair
Cheryl Hughes, LICSW
Rachel Adams, MD
Respiratory care
Strategies and technology for safer mechanical ventilation
Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.
An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO2. Fewer nonactionable alarms can result in greater attention when alarms do occur.
Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.
Brian Walsh, PhD, RRT, NetWork Member
Jonathan Waugh, PhD, RRT, Steering Committee Member
Sleep medicine
Treatment-emergent central apnea may be a frequent cause of PAP nonadherence
Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).
TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).
TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).
Kara Dupuy-McCauley, MD
Fellow-in-Training Member
Caroline Okorie, MD, MPH
Steering Committee Member
Thoracic oncology
Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past
The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).
Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”
Abbie Begnaud, MD
Steering Committee Member
Reading list
Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.
Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.
Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.
Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.
Occupational and environmental health
Occupations at risk for COVID-19
As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.
Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.
Mary Beth Scholand, MD, FCCP – Vice-Chair
Jun She, MD, PhD – Steering Committee Member
Palliative and end-of-life care
Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic
The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”
Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:
- Encouraging values assessment and goals of care for alignment of treatment plans.
- Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
- Facilitating multidisciplinary video family meetings and clinical updates.
- Supporting ICU staff to alleviate moral distress and fatigue.
- Developing and distributing bereavement programs and remembrance rituals.
- Training and education on COVID-specific communication tools.
- Expanding outreach to patients/families through telehealth volunteer programs.
This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).
Tara Coles, MD
Hunter Groninger, MD, Vice Chair
Cheryl Hughes, LICSW
Rachel Adams, MD
Respiratory care
Strategies and technology for safer mechanical ventilation
Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.
An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO2. Fewer nonactionable alarms can result in greater attention when alarms do occur.
Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.
Brian Walsh, PhD, RRT, NetWork Member
Jonathan Waugh, PhD, RRT, Steering Committee Member
Sleep medicine
Treatment-emergent central apnea may be a frequent cause of PAP nonadherence
Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).
TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).
TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).
Kara Dupuy-McCauley, MD
Fellow-in-Training Member
Caroline Okorie, MD, MPH
Steering Committee Member
Thoracic oncology
Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past
The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).
Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”
Abbie Begnaud, MD
Steering Committee Member
Reading list
Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.
Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.
Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.
Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.
Occupational and environmental health
Occupations at risk for COVID-19
As the COVID-19 pandemic has not yet ended, some occupational risks are faced day-to-day. Individuals have been practicing social distancing by working from home in recent months. While this arrangement can be a great way to reduce one’s exposure to COVID-19, it’s a luxury that’s available to just 29% of Americans. The situation for the remaining 71% is uncertain. The individuals on the front lines, whether they’re taking care of patients or stocking grocery shelves, may face a high risk of potential exposure to the virus (Baker et al. PLoS One. 2020; 15[4]:e0232452. doi: 10.1371/journal.pone.0232452).The high risk of the occupations lies in the close contact with people, such as pulmonologists, dentists, and ENT doctors and nurses using tools to lavage during aerosol-generating procedures (She et al. Clin Transl Med. 2020;9(1):19. doi: 10.1186/s40169-020-00271-z). Also, barbers, teachers, beauticians, fitness coaches, stewardesses, kindergarten teachers, chefs, waiters, etc, are required to be in contact with others facing the threat of infection.
Raising awareness of the issues will help avoid occupational transmission of COVID-19. Medical masks, N95 respirators, and hand hygiene are evidenced for high-risk, aerosol or non-aerosol-generating procedures offer protection against viral respiratory infection exposure in the pandemic (She et al. and Bartoszko et al. Influenza Other Respir Viruses. 2020;14(4):365. doi: 10.1111/irv.12745). In addition, using datasets to allow us to assign a more quantitative figure to each occupation’s level of risk to develop a protection strategy is imperative.
Mary Beth Scholand, MD, FCCP – Vice-Chair
Jun She, MD, PhD – Steering Committee Member
Palliative and end-of-life care
Palliative care and critical care mutualism: innovative support during the COVID-19 pandemic
The ICU is the epitome of a complex adaptive system (CAS), a highly organized and structured system that nonetheless is constantly evolving and adapting to changing needs and circumstances (Waldrom. Complexity: The Emerging Science at the Edge of Order and Chaos. Simon & Schuster, New York. 1992). This has never been more apparent than during the current novel coronavirus pandemic. Previously, medical advances and quality improvement projects were carefully vetted, slowly designed, willingly implemented. Today, health systems and society must take rapid and radical leaps to iterate policies and procedures in real time. Deeply embedding and consulting specialized palliative care teams early and often for hospitalized COVID-19 patients is a best practice strategy that benefits patients, families, and staff, and allows critical care teams to function at the top of their expertise. As one of our critical care physician colleagues noted, “Palliative care needs rise with critical care needs – we must help each other innovate practices.”
Beyond complex symptom management and relief of suffering, palliative care’s foundation is providing support during times of uncertainty and ambiguity. This proficiency is now an imperative. Here are some highly relevant examples of current palliative care initiatives within the ICU:
- Encouraging values assessment and goals of care for alignment of treatment plans.
- Advanced care planning with identification of primary and secondary health-care proxies in the setting of potential concurrent infections within families.
- Facilitating multidisciplinary video family meetings and clinical updates.
- Supporting ICU staff to alleviate moral distress and fatigue.
- Developing and distributing bereavement programs and remembrance rituals.
- Training and education on COVID-specific communication tools.
- Expanding outreach to patients/families through telehealth volunteer programs.
This is an opportunity to strengthen the multidisciplinary model of care in the ICU. It may appear that there is an abyss at the edge of chaos, but palliative care is helping engineer and build enduring bridges to help us all cross safely to the other side (Bilder and Knudsen. Front Psychol. 2014 Sep 30. doi: 10.3389/fpsyg.2014.01104).
Tara Coles, MD
Hunter Groninger, MD, Vice Chair
Cheryl Hughes, LICSW
Rachel Adams, MD
Respiratory care
Strategies and technology for safer mechanical ventilation
Clinicians often focus on safe practice as “vigilance in the moment” while interacting with patients and the health-care team and rightly so, especially with mechanical ventilation. New strategies for increasing safety include a more pre-emptive, technology-assisted approach. Alarm fatigue/flooding are serious concerns, and the ECRI found less than 15% of clinical alarms studied (including mechanical ventilation) were “clinically relevant” (eg, requiring some form of action) (ECRI Institute 2018; Plymouth Meeting, PA). Most alarms in health care are set to an “average” patient but as with tailored treatment in precision medicine, it is possible to tune alarm parameters to individual characteristics, including using patient trend data.
An excessive amount of alarms in a clinical environment is thought to be the largest contributing factor to alarm-related adverse events with rates sometimes exceeding 900 alarms per day (Graham et al. Am J Crit Care. 2010;19(1):28-34; quiz 35. doi: 10.4037/ajcc2010651). Human response to stimuli suggests response to alarms is closely matched to the perceived reliability of the alarm system. Instead of alarms based upon single physiological variables, the next generation of smart alarms is integrating much more information than previously possible to reduce false alarms and give more useful alerts. Trend data can better guide interpretation and activation of immediate alarm triggers. For example, a composite ventilation alarm could be created from the integration of trends of respiratory frequency, minute volume, oxygen saturation of hemoglobin, and end-tidal CO2. Fewer nonactionable alarms can result in greater attention when alarms do occur.
Integrated monitoring of patient data trends can also prompt clinicians when a different ventilation mode or setting combination should be considered, especially when indicated by consensus guidelines. The human factor of no-fault, peer audits can improve alarm policy compliance and guide the refinement of alarm policies. Most ventilator manufacturers are developing smart, precise patient monitoring and alarms, and their potential needs to be converted to practice as quickly as possible.
Brian Walsh, PhD, RRT, NetWork Member
Jonathan Waugh, PhD, RRT, Steering Committee Member
Sleep medicine
Treatment-emergent central apnea may be a frequent cause of PAP nonadherence
Treatment-emergent central apnea (TECSA) refers to new onset central-disordered breathing events after initiating treatment of obstructive sleep apnea (OSA), such as with positive airway pressure (PAP) therapy. The nature of the phenomenon is uncertain, but some theorize that in patients with ventilatory instability, CPAP intermittently lowers the partial pressure of PcCO2 below apneic threshold, causing a central apnea event (Gilmartin et al. Curr Opin Pulm Med. 2005;11[6]:485).
TECSA develops in 3.5% to 19.8% of patients starting PAP therapy for OSA. Risk factors include high baseline apnea or arousal index, higher CPAP pressure, older age, male sex, low BMI, and presence of heart failure or ischemic heart disease (Moro et al. Nat Sci Sleep. 2016;8:259; Nigam et al. Ann Thorac Med. 2016;11[3]:202). Most cases resolve in weeks to months; however, an estimated 14.3% to 46.2% evolve into treatment persistent central sleep apnea. Up to 4.2% of patients develop delayed TECSA (D-TECSA) or the emergence of central events after at least a month of PAP therapy (Nigam et al. Ann Thorac Med. 2018;13[2]:86).
TESCA can lead to PAP intolerance (discomfort, gasping, fragmented sleep), lower usage of PAP, and increased likelihood of discontinuing PAP therapy in the first 90 days (Liu et al. Chest. 2017;152[4]:751). When a patient presents with initial or delayed PAP intolerance or persistent symptoms, sleep providers should consider TECSA as a potential etiology. The diagnosis may be made by reviewing data from the patient’s PAP device, or by repeat testing. When encountering persistent TECSA, one can consider lowering the PAP pressure, or performing polysomnography with the goal of titrating the patient to an alternative PAP modality, such as bilevel ST or Adapto Servo Ventilation, which can stabilize breathing in patients with compromised ventilatory control (Morgenthaler et al. Sleep. 2014;37[5]:927).
Kara Dupuy-McCauley, MD
Fellow-in-Training Member
Caroline Okorie, MD, MPH
Steering Committee Member
Thoracic oncology
Times, they are a-changing: Lung cancer outcomes improve and the time for nihilism is past
The American Cancer Society 2020 Facts and Figures reported the largest single year drop in overall cancer mortality ever: 2.2% from 2016 to 2017. This record decrease was driven by the decline in lung cancer deaths thanks to treatment advances such as immunotherapy and targeted drugs for specific lung cancer mutations, combined with declining smoking rates. Lung cancer 5-year survival rates are 19% now and should continue rising, especially if screening rates increase. Immunotherapy has shown a 5-fold increase in survival for advanced non–small cell lung cancer (NSCLC) compared with chemotherapy (13.4% vs 2.6%) and half of metastatic NSCLC patients treated with first-line pembrolizumab were alive after 2 years (vs 34% of chemotherapy patients). Targeted therapies (eg, crizotinib) are similarly encouraging with half of stage IV, ALK-positive NSCLC patients diagnosed after 2009 alive 6.8 years later, compared with just 2% of those diagnosed between 1995 and 2001. Pulmonologists have an important role to play in early detection (screening) and identification of candidates for targeted therapy (ordering mutational analysis on diagnostic specimens).
Exciting treatment advances compel us to more aggressively diagnose lung cancer with early detection and offer diagnostic procedures, even for patients presenting with advanced disease. In fact, improving outcomes are opening the door to curative-intent treatment of oligometastatic lung cancer. In addition to improved disease outcomes, most new therapies are much better tolerated by patients than traditional cytotoxic chemotherapy. No longer is the appropriate response to an ugly-looking lung mass to “get your affairs in order.”
Abbie Begnaud, MD
Steering Committee Member
Reading list
Pacheco JM, Gao D, Smith D, et al. Natural history and factors associated with overall survival in stage IV ALK-rearranged non-small cell lung cancer. J Thorac Oncol. 2019;14(4):691. doi: 10.1016/j.jtho.2018.12.014.
Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin. 2020;70(1):7. doi: 10.3322/caac.21590.
Silvestri GA, Carpenter MJ. Smoking trends and lung cancer mortality: the good, the bad, and the ugly. Ann Intern Med. 2018;169(10):721-722. doi: 10.7326/M18-2775.
Stephens SJ, Moravan MJ, Salama JK. Managing patients with oligometastatic non-small-cell lung cancer. J Oncol Pract. 2018;14(1):23. doi: 10.1200/JOP.2017.026500.
Studies report prolonged long-term survival with immunotherapy vs chemotherapy in advanced NSCLC. ASCO Post October 10, 2019.
CHEST annual meeting 2020
Greetings,
As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!
As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”
Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.
Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.
While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.
In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.
We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.
Best,
Victor Test, MD, FCCP
Greetings,
As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!
As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”
Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.
Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.
While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.
In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.
We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.
Best,
Victor Test, MD, FCCP
Greetings,
As the Program Chair of CHEST Annual Meeting 2020, I’m excited to finally share the good news with all of you – our premiere educational event, CHEST 2020, will be taking place October 18-21! As you might have guessed, we’re migrating the meeting onto a virtual platform - not only will this change ensure your safety, it will enable so many more of you to attend. Colleagues who may have been excluded due to geographical restrictions in the past will now have the opportunity to experience all that we have to offer!
As always, we’ll be bringing you the latest, most relevant clinical topics in pulmonary, critical care, and sleep medicine. From COVID-19 to cultural diversity, we’ve carefully curated sessions to explore the issues that you want to learn about. Not to mention, our speakers are all experts in their field – at the forefront of the pandemic – and will bring a level of knowledge and insight to the meeting that is truly unparalleled. Afterall, that’s what our annual meeting is known for. Regardless of where or how it is taking place, it’s still “the very best of CHEST.”
Other highlights will include over 88 live sessions, including panel and case-based discussions, original investigation presentations with new, unpublished research, and CHEST Games.
Of course, we will have several networking opportunities where you will be able to connect with so many more of your colleagues because of the virtual nature of the meeting. While you may be sitting worlds apart, you’ll be socializing in an intimate online space.
While this isn’t exactly what we imagined for our meeting, it’s what we had to reimagine. Sometimes being pushed out of your comfort zone can lead to something extraordinary, and, in this instance, we think it did.
In closing, I’d like to acknowledge how challenging these past several months have been. For all the long hours, the time spent away from family, and the stress that continues to pile on – this is your chance to unplug and unwind.
We all need an event to look forward to right now, and at CHEST, we’ve worked hard to bring you one. I hope you’ll visit chestmeeting.chestnet.org to register for CHEST 2020.
Best,
Victor Test, MD, FCCP
News from your CHEST Foundation
As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.
Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.
“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois
As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.
Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.
“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois
As the NetWorks Challenge draws to a close, CHEST Foundation staff want to thank every member who donated to support this year’s drive for our COVID-19 Community Grants. When the fund was established in April, we started with a pool of $60,000 to award to patient support groups and small community organizations providing resources and interventions for those most vulnerable to develop severe complications from COVID-19 – American’s living with chronic lung disease. Within 2 months, we’d awarded all available funds to 25 organizations and had several others still seeking funding. The lion’s share of these groups were providing direct service to medically fragile and isolated patients – purchasing PPE, cleaning supplies, pulse oximeters, and even groceries to patients who otherwise wouldn’t have access to these critical supplies.
Because of YOUR support of the NetWorks Challenge, we are proud to share that we are providing an additional $43,850 in support of COVID-19 Community Grants. Because of you – we can continue to provide vital funding to support group members who lives’ you’ve changed forever.
“Receiving the CHEST Foundation grant for COVID-19 support was a real boost to all of our spirits. Our staff have been working tirelessly to care for our residents 24/7, and there have been some trying and exhausting moments. When we received the community-based grant, it reminded us that there are still people in our community cheering us on, and it’s an acknowledgment that our clients matter just as much to the community as they do to us, personally.” –– Katherine A. Brown, St. Coletta’s of Illinois
e-Interview With CHEST President-Elect Steven Q. Simpson, MD, FCCP
CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.
As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would you like to accomplish as President of CHEST?
This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.
1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.
2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.
3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.
4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).
Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.
The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
What are some challenges facing CHEST, and how will you address these challenges?
The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!
CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.
As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would you like to accomplish as President of CHEST?
This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.
1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.
2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.
3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.
4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).
Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.
The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
What are some challenges facing CHEST, and how will you address these challenges?
The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!
CHEST President-Elect Steven Q. Simpson, MD, FCCP, is Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at the University of Kansas. He is also senior advisor to the Solving Sepsis initiative of the Biomedical Advanced Research and Development Authority (BARDA) of the US Department of Health and Human Services.
As we greet our new incoming CHEST President, we asked him for a few thoughts about his upcoming presidential year. He kindly offered these responses:
What would you like to accomplish as President of CHEST?
This is an interesting question, because a global pandemic and other developments in our world dictate that our organizational goals must adapt to a landscape that has shifted in recent months. My goals as President are somewhat different from what I stated when I ran for the office.
1. First, I will build on the efforts of my predecessors to ensure that CHEST is an inclusive and anti-racist organization. All CHEST members must have equal opportunities within our organization to advance their lives and their careers, regardless of race, ethnicity, sex, or gender. My goal is to examine our structures for participation and advancement to positions of leadership in the organization and to evaluate our educational and research offerings, all with the purpose of discovering and remedying places where we have been blind to our own systematic bias. Further, CHEST must advocate for and lead others to advocate for equality, for equal access to medical care, and for policies that promote them. We must be leaders in this arena, through both our voice and our actions.
2. We will build on CHEST’s new initiative to support the wellness of our members and to help us all perform at our best, day in and day out. I hope for our newly established Wellness Center to become a frequent stop for all CHEST members, myself included, to help us to sustain ourselves through the pandemic and beyond.
3. We must maintain both the quality and the feel of our educational and research offerings during this time when we cannot come together in person. My goal for us is that we use this time to embrace remote and nontemporally synchronous education, ie, web-based education, to make CHEST’s offerings the best anywhere. In the remainder of the 21st century, digital transformation of teaching and learning will advance tremendously, and our creative use of technology will become a norm. I hope that we never abandon in-person meetings, but using technology to improve information transfer and augmenting our members’ continuing education are clearly here to stay. My goal for us is that we maintain an atmosphere to both our in-person meetings and our remotely delivered meetings that makes generating new knowledge and learning what we generate enjoyable, even fun. I believe our digital transformation will make some interesting things possible over time.
4. My overall goal for CHEST in the coming year is not that we “make it through” the current pandemic, but that we emerge stronger, smarter, and better for the experience, and prepared for the next challenge(s).
Before COVID-19, I had goals for my presidency, and these issues have not disappeared. CHEST needs to be user- friendly for our members, from our website, to the ways in which we deliver education, to the type of research we develop and promote. On the research side, our members have long been interested in clinical research that informs and improves our patient care. My goal is to double down on promoting, supporting, and presenting research that serves exactly this purpose. We are growing our team-based education, and I have a special goal for CHEST to become the home for pulmonary, critical care, and sleep advanced practice providers. I care tremendously about our international members, and I will promote both international growth and catering of CHEST’s offerings to benefit our international members.
What do you consider to be the greatest strength of CHEST, and how will you build upon this during your Presidency?
There is zero doubt that CHEST’s greatest strength is the people who gravitate to our organization. From pure clinicians to academicians; from clinical researchers to clinical educators to outcomes mavens—all levels of the health-care team. At every level of this organization are members who all want to be better at what we do, who want to figure out the ways for doing that, who want to explore the boundaries of what that means, and who want to help others to do the same. That goes, as well, for the professional staff who support the members, and who have adopted the motto, “CRUSH lung disease,” because they share our mission and are here to help us do it better.
The absolutely most enjoyable thing about leadership is having the opportunity to survey the landscape and see who’s looking for opportunity, who’s a rising star, who’s looking for people to mentor, then matching those people with opportunities and with jobs to do. Good people who are motivated by the right principles rise to the occasion. My job as President is to help ensure that the organization via the CHEST Board of Regents is addressing the correct problems with the right vision, to identify the right talented and dedicated members for the jobs, and then to support and stay out of their way as they make the vision a reality.
What are some challenges facing CHEST, and how will you address these challenges?
The major immediate challenges facing CHEST are pandemic-related, in terms of helping to ensure the well-being of our members, and in helping them to address the inequities and disparities in care for our patients of color, who have been hardest hit by the emergence of SARS-CoV-2. I addressed these with my goals, above. To be more specific, though, our board will be using various techniques, including dialogue with our members of color, to understand and address our own implicit biases, so that we can achieve the correct vision and tone of inclusion for all of our members. Also addressed in my goals is the isolation from one another that we are all experiencing because of the pandemic. This situation makes it difficult for us to maintain the style and tone of live learning experiences that our CHEST members are accustomed to. The challenge is to develop materials that can be interactive at a distance, and this likely includes gamification of educational content and employing virtual reality. CHEST Innovations is already working in this arena, and it will be our job as member volunteers to support those efforts. The isolation affects our international members, as well, and our ability to travel to maintain relationships. The nice thing is that web conferencing works just as well for international meetings as for meetings in the US, although somebody often has to go to bed very late or get up very early in the morning to make them work! The efforts are worth our time. Again, we will be working in various arenas to maintain and grow our international relationships.
And finally, what is your charge to the members and new Fellows (FCCPs) of CHEST?
We do not yet see clearly whether to expect a massive winter surge of COVID-19 infections. However, it is a reasonably likely possibility. My charge to our members and our new Fellows is first to stay safe, yourself, and to take care of your mental and physical well-being, so that you can be present and functioning at peak levels for your patients. Make sure your family is, likewise, being safe. Secondly, keep doing what you do, which is excellent patient care, excellent teaching, excellent research to push the boundaries of our knowledge. And finally, you’ve seen my ideas of the challenges facing CHEST. I want you to survey, yourself, and tell me what you think our challenges, goals, and responsibilities should be. And if anything I’ve said resonates with you, volunteer to help us address our challenges and keep CHEST the professional home that you deserve and that you will never want to leave. CHEST wants you and needs you. We are so happy you are with us!