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Joint society task force releases strategic plan on climate change
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
Key takeaway: As a procedure-intense subspecialty, gastroenterology, and in particular endoscopy, is a major contributor to health care’s carbon footprint and other environmental impacts. Endoscopy is the third largest generator of medical waste in a hospital (2 kg total waste per procedure) with most ending in landfills. With this strategic plan, the participating societies are committed to promoting and supporting a sustainable, high-quality GI practice.
The U.S. GI multisociety strategic plan, which has also been endorsed by 23 GI societies globally, is a collaborative effort that invites members to undertake initiatives to establish an environmentally sustainable, high-quality practice and promote planetary health. Each society will prioritize and adapt their initiatives in accordance with their individual societal goals. Some initiatives may be undertaken by a single society, whereas other objectives and initiatives may be approached jointly. It is a 5-year plan that covers seven major domains:
- Clinical setting.
- Education.
- Research.
- Society efforts.
- Intersociety efforts.
- Industry.
- Advocacy.
The plan was developed by the U.S. Multi-GI Society Task Force on Climate Change, which is composed of leading experts from AASLD, ACG, AGA, and ASGE.
For more information, view the full publication: GI Multisociety Strategic Plan on Environmental Sustainability, published in Gastroenterology, Gastrointestinal Endoscopy, HEPATOLOGY, and The American Journal of Gastroenterology.
What to know about 2023 Medicare payments
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
The Centers for Medicare and Medicaid Services released its final rules for 2023 Medicare payments.
Good news! The full CRC continuum will be covered in Medicare.
In a win for patients and thanks to our collective advocacy efforts from AGA and partner societies, CMS expanded the regulatory definition of “colorectal cancer screening tests” and will waive cost sharing for a necessary follow-up colonoscopy after a positive stool-based screening test.
Bad news: Looming cuts on the horizon, GI societies to take action.
The rule finalizes more than 4% in mandated Medicare physician reimbursement cuts through decreases in the conversion factor and expiration of temporary fixes passed by Congress. The CY 2023 conversion factor is $33.06, an unacceptable cut for our members. The GI societies continue to work with a coalition of national and state medical societies to urge Congress to prevent these cuts before Jan. 1, 2023.
Good news: ASC + hospital payments on the rise.
ASC payments and facility fee payments increase 3.8% for institutions that meet quality reporting requirements. The CY 2023 ASC conversion factor is $51.854 and the hospital outpatient conversion factor is $85.585.
CMS removed motility codes 91117 and 91122 from APC 5731, where their payments would have been cut 21%, and finalized their placement in APC 5722, where they get a 3% payment increase beginning Jan. 1, 2023. Thank you to the motility community for helping us secure this win.
CMS raises the hospital payment for ESD code C9779 to $3,260.69, a $765.65 increase from 2022. We continue to work with CMS on our request for separate codes for lower ESD and upper ESD and payments that better reflect their unique resource costs.
New AGA guideline ranks the most effective drugs for weight loss
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
The following medications, paired with healthy eating and regular physical activity, are first-line medical options and result in moderate weight loss as noted as a percentage of body weight (reported as the difference compared to percent weight loss observed in the placebo group).
- Semaglutide (Wegovy®), weight loss percentage: 10.8%
- Phentermine-topiramate ER (Qsymia®), weight loss percentage: 8.5%
- Liraglutide (Saxenda®), weight loss percentage: 4.8%
- Naltrexone-bupropion ER (Contrave®), weight loss percentage: 3.0%
Read the AGA Clinical Guidelines on Pharmacological Interventions for Adults with Obesity for the complete recommendations.
An appeal from Michael Camilleri, MD, DSc, AGAF
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.
This holiday season is a good time to reflect on our many blessings and thank those who have helped make our lives and careers worthwhile, successful, and prosperous. What better way than to pass on something to those who will ensure that gastroenterology will advance in decades to come?
Progress in this lifesaving work is made possible by the generosity of many supporters, like you, who understand the devastating physical, emotional, and financial costs of digestive diseases. We simply cannot allow a slowdown in the pace of GI research, and we cannot afford to lose talent when research offers so much promise for the future.
You can make a difference to ensure the progress continues.
The AGA Research Foundation funds promising young investigators who might not receive funding otherwise at crucial times in their early careers. The research of these talented individuals, while important to the field, if left unfunded, could end prematurely. That’s something the field can’t afford, and that’s why I’ve supported the AGA Research Foundation over the years through my donations.
We must maintain a robust pipeline of research that will help safeguard the success of clinical medicine. I urge you to support the future of GI with a generous donation to the AGA Research Foundation. Your investment of $100, $250, $500, $1,000, or any amount you can give today will make a difference.
Help close the gap in research funding and make a difference. Make your tax-deductible donation online at www.gastro.org/donateonline.
Thank you in advance for support and best wishes for a happy, healthy holiday season and prosperous New Year.
Three easy ways to give
Online: www.gastro.org/donateonline
Through the mail:
AGA Research Foundation
4930 Del Ray Avenue
Bethesda, MD 20814
Over the phone: 301-222-4002
Dr. Camilleri is chair of the AGA Research Foundation, past-president of the AGA Institute, and a consultant in the division of gastroenterology and hepatology, Mayo Clinic, Rochester, Minn.
Thoracic Oncology & Chest Imaging Network
Ultrasound & Chest Imaging Section
VExUS scan: The missing piece of hemodynamic puzzle?
Volume status and tailoring the correct level of fluid resuscitation is challenging for the intensivist. Determining “fluid overload,” especially in the setting of acute kidney injury, can be difficult. While a Swan-Ganz catheter, central venous pressure, or inferior vena cava (IVC) ultrasound measurement can suggest elevated right atrial pressure, the effect on organ level hemodynamics is unknown.
Abdominal venous Doppler is a method to view the effects of venous pressure on abdominal organ venous flow. An application of this is the Venous Excess Ultrasound Score (VExUS) (Rola, et al. Ultrasound J. 2021;13[1]:32). VExUS uses IVC diameter and pulse wave doppler waveforms from the hepatic, portal, and renal veins to grade venous congestion from none to severe. Studies demonstrate an association between venous congestion and renal dysfunction in cardiac surgery (Beaubien-Souligny, et al. Ultrasound J. 2020;12[1]:16) and general ICU patients (Spiegel, et al. Crit Care. 2020;24[1]:615).
This practice of identifying venous congestion and avoiding over-resuscitation could improve patient care. However, acquiring quality images and waveforms may prove to be difficult, and interpretation may be confounded by other disease states such as cirrhosis. Though it is postulated that removing fluid could be beneficial to patients with high VExUS scores, this has yet to be proven and may be difficult to prove. While the score estimates volume status well, the source of venous congestion is not identified such that it should be used as a clinical supplement to other data.
VExUS has a strong physiologic basis, and early clinical experience indicates a strong role in improving assessment of venous congestion, an important aspect of volume status. This is an area of ongoing research to ensure appropriate and effective use.
Kyle Swartz, DO
Steven Fox, MD
John Levasseur, DO
Ultrasound & Chest Imaging Section
VExUS scan: The missing piece of hemodynamic puzzle?
Volume status and tailoring the correct level of fluid resuscitation is challenging for the intensivist. Determining “fluid overload,” especially in the setting of acute kidney injury, can be difficult. While a Swan-Ganz catheter, central venous pressure, or inferior vena cava (IVC) ultrasound measurement can suggest elevated right atrial pressure, the effect on organ level hemodynamics is unknown.
Abdominal venous Doppler is a method to view the effects of venous pressure on abdominal organ venous flow. An application of this is the Venous Excess Ultrasound Score (VExUS) (Rola, et al. Ultrasound J. 2021;13[1]:32). VExUS uses IVC diameter and pulse wave doppler waveforms from the hepatic, portal, and renal veins to grade venous congestion from none to severe. Studies demonstrate an association between venous congestion and renal dysfunction in cardiac surgery (Beaubien-Souligny, et al. Ultrasound J. 2020;12[1]:16) and general ICU patients (Spiegel, et al. Crit Care. 2020;24[1]:615).
This practice of identifying venous congestion and avoiding over-resuscitation could improve patient care. However, acquiring quality images and waveforms may prove to be difficult, and interpretation may be confounded by other disease states such as cirrhosis. Though it is postulated that removing fluid could be beneficial to patients with high VExUS scores, this has yet to be proven and may be difficult to prove. While the score estimates volume status well, the source of venous congestion is not identified such that it should be used as a clinical supplement to other data.
VExUS has a strong physiologic basis, and early clinical experience indicates a strong role in improving assessment of venous congestion, an important aspect of volume status. This is an area of ongoing research to ensure appropriate and effective use.
Kyle Swartz, DO
Steven Fox, MD
John Levasseur, DO
Ultrasound & Chest Imaging Section
VExUS scan: The missing piece of hemodynamic puzzle?
Volume status and tailoring the correct level of fluid resuscitation is challenging for the intensivist. Determining “fluid overload,” especially in the setting of acute kidney injury, can be difficult. While a Swan-Ganz catheter, central venous pressure, or inferior vena cava (IVC) ultrasound measurement can suggest elevated right atrial pressure, the effect on organ level hemodynamics is unknown.
Abdominal venous Doppler is a method to view the effects of venous pressure on abdominal organ venous flow. An application of this is the Venous Excess Ultrasound Score (VExUS) (Rola, et al. Ultrasound J. 2021;13[1]:32). VExUS uses IVC diameter and pulse wave doppler waveforms from the hepatic, portal, and renal veins to grade venous congestion from none to severe. Studies demonstrate an association between venous congestion and renal dysfunction in cardiac surgery (Beaubien-Souligny, et al. Ultrasound J. 2020;12[1]:16) and general ICU patients (Spiegel, et al. Crit Care. 2020;24[1]:615).
This practice of identifying venous congestion and avoiding over-resuscitation could improve patient care. However, acquiring quality images and waveforms may prove to be difficult, and interpretation may be confounded by other disease states such as cirrhosis. Though it is postulated that removing fluid could be beneficial to patients with high VExUS scores, this has yet to be proven and may be difficult to prove. While the score estimates volume status well, the source of venous congestion is not identified such that it should be used as a clinical supplement to other data.
VExUS has a strong physiologic basis, and early clinical experience indicates a strong role in improving assessment of venous congestion, an important aspect of volume status. This is an area of ongoing research to ensure appropriate and effective use.
Kyle Swartz, DO
Steven Fox, MD
John Levasseur, DO
Critical Care Network
Sepsis/Shock Section
Fluid Resuscitation – Back to BaSICS
The age-old debate regarding the appropriate timing, volume, and type of fluid resuscitation for patients in septic shock rages on – or does it? In October 2021, the Surviving Sepsis Campaign published updated guidelines for the management of sepsis. One of the biggest changes from prior versions was downgrading the recommendation for an initial 30mL/kg bolus of IV crystalloid for the initial resuscitation of a patient in septic shock to a suggestion, based on dynamic measures to assess individual patients’ fluid balance (Evans, et al. Crit Care Med. 2021;49[11]:e1063-e1143).
Traditionally, 0.9% saline had been the resuscitative fluid of choice in sepsis. But it has a propensity to cause physiologic derangements such as hyperchloremic metabolic acidosis, renal afferent vasoconstriction, and reduced glomerular filtration rate – not to mention, can be a signal for possibly increased mortality, as seen in the SMART trial (Semler, et al. N Engl J Med. 2018;378[9]:829-839). Normal saline had subsequently fallen from grace in favor of balanced crystalloids such as Lactated Ringer’s and Plasma-Lyte. However, the recent PLUS and BaSICS trials showed no significant difference in 90-day mortality or secondary outcomes of acute kidney injury, need for renal replacement therapy, or ICU mortality (Finfer, et al. N Engl J Med. 2022;386[9]:815-826; Zampieri, et al. JAMA. 2021;326[9]:818-829). While these are large randomized controlled trials, a major weakness is the administration of uncontrolled resuscitative fluids prior to randomization and even postenrollment, which may have biased results.
Ultimately, does the choice between salt water or balanced crystalloids matter? Despite the limitations in the newest trials, probably less than the timely administration of antibiotics and pressors, unless your patient also has a traumatic TBI – then go with the saline. But, in the everlasting quest for medical excellence, choosing the balanced fluid that causes the least physiologic derangement seems to make the most sense.
LCDR Meredith Olsen, MD, USN
Ankita Agarwal, MD
The views expressed are those of the authors and do not reflect the official policy or position of the U.S. Navy, Department of Defense, or the U.S. Government.
Sepsis/Shock Section
Fluid Resuscitation – Back to BaSICS
The age-old debate regarding the appropriate timing, volume, and type of fluid resuscitation for patients in septic shock rages on – or does it? In October 2021, the Surviving Sepsis Campaign published updated guidelines for the management of sepsis. One of the biggest changes from prior versions was downgrading the recommendation for an initial 30mL/kg bolus of IV crystalloid for the initial resuscitation of a patient in septic shock to a suggestion, based on dynamic measures to assess individual patients’ fluid balance (Evans, et al. Crit Care Med. 2021;49[11]:e1063-e1143).
Traditionally, 0.9% saline had been the resuscitative fluid of choice in sepsis. But it has a propensity to cause physiologic derangements such as hyperchloremic metabolic acidosis, renal afferent vasoconstriction, and reduced glomerular filtration rate – not to mention, can be a signal for possibly increased mortality, as seen in the SMART trial (Semler, et al. N Engl J Med. 2018;378[9]:829-839). Normal saline had subsequently fallen from grace in favor of balanced crystalloids such as Lactated Ringer’s and Plasma-Lyte. However, the recent PLUS and BaSICS trials showed no significant difference in 90-day mortality or secondary outcomes of acute kidney injury, need for renal replacement therapy, or ICU mortality (Finfer, et al. N Engl J Med. 2022;386[9]:815-826; Zampieri, et al. JAMA. 2021;326[9]:818-829). While these are large randomized controlled trials, a major weakness is the administration of uncontrolled resuscitative fluids prior to randomization and even postenrollment, which may have biased results.
Ultimately, does the choice between salt water or balanced crystalloids matter? Despite the limitations in the newest trials, probably less than the timely administration of antibiotics and pressors, unless your patient also has a traumatic TBI – then go with the saline. But, in the everlasting quest for medical excellence, choosing the balanced fluid that causes the least physiologic derangement seems to make the most sense.
LCDR Meredith Olsen, MD, USN
Ankita Agarwal, MD
The views expressed are those of the authors and do not reflect the official policy or position of the U.S. Navy, Department of Defense, or the U.S. Government.
Sepsis/Shock Section
Fluid Resuscitation – Back to BaSICS
The age-old debate regarding the appropriate timing, volume, and type of fluid resuscitation for patients in septic shock rages on – or does it? In October 2021, the Surviving Sepsis Campaign published updated guidelines for the management of sepsis. One of the biggest changes from prior versions was downgrading the recommendation for an initial 30mL/kg bolus of IV crystalloid for the initial resuscitation of a patient in septic shock to a suggestion, based on dynamic measures to assess individual patients’ fluid balance (Evans, et al. Crit Care Med. 2021;49[11]:e1063-e1143).
Traditionally, 0.9% saline had been the resuscitative fluid of choice in sepsis. But it has a propensity to cause physiologic derangements such as hyperchloremic metabolic acidosis, renal afferent vasoconstriction, and reduced glomerular filtration rate – not to mention, can be a signal for possibly increased mortality, as seen in the SMART trial (Semler, et al. N Engl J Med. 2018;378[9]:829-839). Normal saline had subsequently fallen from grace in favor of balanced crystalloids such as Lactated Ringer’s and Plasma-Lyte. However, the recent PLUS and BaSICS trials showed no significant difference in 90-day mortality or secondary outcomes of acute kidney injury, need for renal replacement therapy, or ICU mortality (Finfer, et al. N Engl J Med. 2022;386[9]:815-826; Zampieri, et al. JAMA. 2021;326[9]:818-829). While these are large randomized controlled trials, a major weakness is the administration of uncontrolled resuscitative fluids prior to randomization and even postenrollment, which may have biased results.
Ultimately, does the choice between salt water or balanced crystalloids matter? Despite the limitations in the newest trials, probably less than the timely administration of antibiotics and pressors, unless your patient also has a traumatic TBI – then go with the saline. But, in the everlasting quest for medical excellence, choosing the balanced fluid that causes the least physiologic derangement seems to make the most sense.
LCDR Meredith Olsen, MD, USN
Ankita Agarwal, MD
The views expressed are those of the authors and do not reflect the official policy or position of the U.S. Navy, Department of Defense, or the U.S. Government.
Pulmonary Vascular & Cardiovascular Network
Pulmonary Vascular Disease Section
Key messages from the 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension
1. Per coverage by the American College of Cardiology, “Pulmonary hypertension (PH) is now defined by a mean pulmonary arterial pressure >20 mm Hg at rest. The definition of pulmonary arterial hypertension (PAH) also implies a pulmonary vascular resistance (PVR) >2 Wood units and pulmonary arterial wedge pressure ≤15 mm Hg.”1 These cut-off values do not translate into new therapeutic recommendations.
2. , involving first suspicion by first-line physicians, then detection by echocardiography, and confirmation with right heart catheterization, preferably in a PH center.
3. Pulmonary vasoreactivity testing is only recommended in patients with idiopathic PAH, heritable PAH, or drug/toxin associated PAH to identify potential candidates for calcium channel blocker therapy. Inhaled nitric oxide or inhaled iloprost are the recommended agents.
4. The role of cardiac MRI in prognostication of patients with PAH has been confirmed such that measures of right ventricular volume, right ventricular ejection fraction, and stroke volume are included as risk assessment variables.
5. The primary limitation of the 2015 ESC/ERS three-strata risk-assessment tool is that 60% to 70% of the patients are classified as intermediate risk (IR). A four-strata risk stratification, dividing the IR group into IR “low” and IR “high” risk, is proposed at follow up.
6. No general recommendation is made for or against the use of anticoagulation in PAH given the absence of robust data and increased risk of bleeding.
7. In patients with PH-ILD, inhaled treprostinil may be considered based on findings from the INCREASE trial, but further long-term outcome data are needed.
8. Improved recognition of the signs of chronic thromboembolic pulmonary hypertension (CTEPH) on CT and echocardiographic imagery at the time of an acute pulmonary embolism (PE) event, along with systematic follow-up of patients with acute PE, is recommended to help mitigate the underdiagnosis of CTEPH.
9. The treatment algorithm for PAH has been simplified, and now includes a focus on cardiopulmonary comorbidities, risk assessment, and treatment goals. Current standards include initial combination therapy and treatment escalation at follow-up, when appropriate.
10. Per coverage by the American College of Cardiology, “The recommendations on sex-related issues in patients with PAH, including pregnancy, have been updated, with information and shared decision making as key points.” Calcium channel blockers, inhaled/IV/subcutaneous prostacyclin analogues, and phosphodiesterase 5 inhibitors all and are considered safe during pregnancy, despite limited data on this use.
11. Per the guideline, “Patients with PAH should be treated with the best standard of pharmacological treatment and be in stable clinical condition before embarking on a supervised rehabilitation program.”2 Additional studies have shown that exercise training has a beneficial impact on 6-minute walk distance, quality of life, World Health Organization function classification, and peak VO2.
12. Immunization of PAH patients against SARS-CoV-2, influenza, and Streptococcus pneumoniae is recommended.
This edition of clinical practice guidelines focuses on early diagnosis of PAH and optimal treatments.
*Mary Jo S. Farmer, MD, PhD
Member-at-Large
Vijay Balasubramanian, MD, MRCP (UK)
Chair
* The authors for this article were listed in the incorrect order in the print edition of CHEST Physician. The order has been corrected here.
References
1. Mukherjee, D. 2022 ESC/ERS guidelines for pulmonary hypertension: key points. American College of Cardiology. August 30, 2022.
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731.
Pulmonary Vascular Disease Section
Key messages from the 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension
1. Per coverage by the American College of Cardiology, “Pulmonary hypertension (PH) is now defined by a mean pulmonary arterial pressure >20 mm Hg at rest. The definition of pulmonary arterial hypertension (PAH) also implies a pulmonary vascular resistance (PVR) >2 Wood units and pulmonary arterial wedge pressure ≤15 mm Hg.”1 These cut-off values do not translate into new therapeutic recommendations.
2. , involving first suspicion by first-line physicians, then detection by echocardiography, and confirmation with right heart catheterization, preferably in a PH center.
3. Pulmonary vasoreactivity testing is only recommended in patients with idiopathic PAH, heritable PAH, or drug/toxin associated PAH to identify potential candidates for calcium channel blocker therapy. Inhaled nitric oxide or inhaled iloprost are the recommended agents.
4. The role of cardiac MRI in prognostication of patients with PAH has been confirmed such that measures of right ventricular volume, right ventricular ejection fraction, and stroke volume are included as risk assessment variables.
5. The primary limitation of the 2015 ESC/ERS three-strata risk-assessment tool is that 60% to 70% of the patients are classified as intermediate risk (IR). A four-strata risk stratification, dividing the IR group into IR “low” and IR “high” risk, is proposed at follow up.
6. No general recommendation is made for or against the use of anticoagulation in PAH given the absence of robust data and increased risk of bleeding.
7. In patients with PH-ILD, inhaled treprostinil may be considered based on findings from the INCREASE trial, but further long-term outcome data are needed.
8. Improved recognition of the signs of chronic thromboembolic pulmonary hypertension (CTEPH) on CT and echocardiographic imagery at the time of an acute pulmonary embolism (PE) event, along with systematic follow-up of patients with acute PE, is recommended to help mitigate the underdiagnosis of CTEPH.
9. The treatment algorithm for PAH has been simplified, and now includes a focus on cardiopulmonary comorbidities, risk assessment, and treatment goals. Current standards include initial combination therapy and treatment escalation at follow-up, when appropriate.
10. Per coverage by the American College of Cardiology, “The recommendations on sex-related issues in patients with PAH, including pregnancy, have been updated, with information and shared decision making as key points.” Calcium channel blockers, inhaled/IV/subcutaneous prostacyclin analogues, and phosphodiesterase 5 inhibitors all and are considered safe during pregnancy, despite limited data on this use.
11. Per the guideline, “Patients with PAH should be treated with the best standard of pharmacological treatment and be in stable clinical condition before embarking on a supervised rehabilitation program.”2 Additional studies have shown that exercise training has a beneficial impact on 6-minute walk distance, quality of life, World Health Organization function classification, and peak VO2.
12. Immunization of PAH patients against SARS-CoV-2, influenza, and Streptococcus pneumoniae is recommended.
This edition of clinical practice guidelines focuses on early diagnosis of PAH and optimal treatments.
*Mary Jo S. Farmer, MD, PhD
Member-at-Large
Vijay Balasubramanian, MD, MRCP (UK)
Chair
* The authors for this article were listed in the incorrect order in the print edition of CHEST Physician. The order has been corrected here.
References
1. Mukherjee, D. 2022 ESC/ERS guidelines for pulmonary hypertension: key points. American College of Cardiology. August 30, 2022.
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731.
Pulmonary Vascular Disease Section
Key messages from the 2022 ESC/ERS Guidelines for the Diagnosis and Treatment of Pulmonary Hypertension
1. Per coverage by the American College of Cardiology, “Pulmonary hypertension (PH) is now defined by a mean pulmonary arterial pressure >20 mm Hg at rest. The definition of pulmonary arterial hypertension (PAH) also implies a pulmonary vascular resistance (PVR) >2 Wood units and pulmonary arterial wedge pressure ≤15 mm Hg.”1 These cut-off values do not translate into new therapeutic recommendations.
2. , involving first suspicion by first-line physicians, then detection by echocardiography, and confirmation with right heart catheterization, preferably in a PH center.
3. Pulmonary vasoreactivity testing is only recommended in patients with idiopathic PAH, heritable PAH, or drug/toxin associated PAH to identify potential candidates for calcium channel blocker therapy. Inhaled nitric oxide or inhaled iloprost are the recommended agents.
4. The role of cardiac MRI in prognostication of patients with PAH has been confirmed such that measures of right ventricular volume, right ventricular ejection fraction, and stroke volume are included as risk assessment variables.
5. The primary limitation of the 2015 ESC/ERS three-strata risk-assessment tool is that 60% to 70% of the patients are classified as intermediate risk (IR). A four-strata risk stratification, dividing the IR group into IR “low” and IR “high” risk, is proposed at follow up.
6. No general recommendation is made for or against the use of anticoagulation in PAH given the absence of robust data and increased risk of bleeding.
7. In patients with PH-ILD, inhaled treprostinil may be considered based on findings from the INCREASE trial, but further long-term outcome data are needed.
8. Improved recognition of the signs of chronic thromboembolic pulmonary hypertension (CTEPH) on CT and echocardiographic imagery at the time of an acute pulmonary embolism (PE) event, along with systematic follow-up of patients with acute PE, is recommended to help mitigate the underdiagnosis of CTEPH.
9. The treatment algorithm for PAH has been simplified, and now includes a focus on cardiopulmonary comorbidities, risk assessment, and treatment goals. Current standards include initial combination therapy and treatment escalation at follow-up, when appropriate.
10. Per coverage by the American College of Cardiology, “The recommendations on sex-related issues in patients with PAH, including pregnancy, have been updated, with information and shared decision making as key points.” Calcium channel blockers, inhaled/IV/subcutaneous prostacyclin analogues, and phosphodiesterase 5 inhibitors all and are considered safe during pregnancy, despite limited data on this use.
11. Per the guideline, “Patients with PAH should be treated with the best standard of pharmacological treatment and be in stable clinical condition before embarking on a supervised rehabilitation program.”2 Additional studies have shown that exercise training has a beneficial impact on 6-minute walk distance, quality of life, World Health Organization function classification, and peak VO2.
12. Immunization of PAH patients against SARS-CoV-2, influenza, and Streptococcus pneumoniae is recommended.
This edition of clinical practice guidelines focuses on early diagnosis of PAH and optimal treatments.
*Mary Jo S. Farmer, MD, PhD
Member-at-Large
Vijay Balasubramanian, MD, MRCP (UK)
Chair
* The authors for this article were listed in the incorrect order in the print edition of CHEST Physician. The order has been corrected here.
References
1. Mukherjee, D. 2022 ESC/ERS guidelines for pulmonary hypertension: key points. American College of Cardiology. August 30, 2022.
2. Humbert M, Kovacs G, Hoeper MM, et al. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731.
Diffuse Lung Disease & Transplant Network
Pulmonary Physiology & Rehabilitation Section
Exercise tolerance in untreated sleep apnea
Numerous cardiovascular, respiratory, neuromuscular, and perceptual factors determine exercise tolerance. This makes designing a study to isolate the contribution of one factor difficult.
A recently published study (Elbehairy, et al. Chest. 2022; published online September 29, 2022) explores exercise tolerance in patients with untreated OSA compared with age- and weight-matched controls. The authors found that at an equivalent work rate, patients with OSA had greater minute ventilation, principally due to higher breathing frequency. Dead space volume, dead space ventilation, and dead space to tidal volume ratio (VD/VT) were higher in patients with OSA, likely due to a reduction in pulmonary vessel recruitment relative to ventilation. VD/VT decreased more from rest to peak in controls than in patients with OSA, an adaptation that is expected with exercise. Patients with OSA had greater arterial stiffness measured by pulse wave velocity and higher blood pressures, which may have affected cardiac output augmentation. Patients with OSA also had higher resting mean pulmonary artery pressures and exercise dyspnea scores. Regression models predicting peak oxygen uptake and peak work rate were statistically significant, with predictors being age, pulse wave velocity, and resting mean pulmonary artery pressure. The role of diastolic dysfunction remains to be determined.
Prior studies have shown that some effects of OSA on exercise may be reversed with CPAP treatment (Arias, et al. Eur Heart J. 2006;27[9]:1106-1113; Chalegre, et al. Sleep Breath. 2021;25[3]:1195-1202). Understanding the mechanisms of exercise limitation in OSA will help physicians address symptoms, reinforce CPAP adherence, and design tailored pulmonary rehabilitation programs.
Fatima Zeba, MD
Fellow-in-Training
Pulmonary Physiology & Rehabilitation Section
Exercise tolerance in untreated sleep apnea
Numerous cardiovascular, respiratory, neuromuscular, and perceptual factors determine exercise tolerance. This makes designing a study to isolate the contribution of one factor difficult.
A recently published study (Elbehairy, et al. Chest. 2022; published online September 29, 2022) explores exercise tolerance in patients with untreated OSA compared with age- and weight-matched controls. The authors found that at an equivalent work rate, patients with OSA had greater minute ventilation, principally due to higher breathing frequency. Dead space volume, dead space ventilation, and dead space to tidal volume ratio (VD/VT) were higher in patients with OSA, likely due to a reduction in pulmonary vessel recruitment relative to ventilation. VD/VT decreased more from rest to peak in controls than in patients with OSA, an adaptation that is expected with exercise. Patients with OSA had greater arterial stiffness measured by pulse wave velocity and higher blood pressures, which may have affected cardiac output augmentation. Patients with OSA also had higher resting mean pulmonary artery pressures and exercise dyspnea scores. Regression models predicting peak oxygen uptake and peak work rate were statistically significant, with predictors being age, pulse wave velocity, and resting mean pulmonary artery pressure. The role of diastolic dysfunction remains to be determined.
Prior studies have shown that some effects of OSA on exercise may be reversed with CPAP treatment (Arias, et al. Eur Heart J. 2006;27[9]:1106-1113; Chalegre, et al. Sleep Breath. 2021;25[3]:1195-1202). Understanding the mechanisms of exercise limitation in OSA will help physicians address symptoms, reinforce CPAP adherence, and design tailored pulmonary rehabilitation programs.
Fatima Zeba, MD
Fellow-in-Training
Pulmonary Physiology & Rehabilitation Section
Exercise tolerance in untreated sleep apnea
Numerous cardiovascular, respiratory, neuromuscular, and perceptual factors determine exercise tolerance. This makes designing a study to isolate the contribution of one factor difficult.
A recently published study (Elbehairy, et al. Chest. 2022; published online September 29, 2022) explores exercise tolerance in patients with untreated OSA compared with age- and weight-matched controls. The authors found that at an equivalent work rate, patients with OSA had greater minute ventilation, principally due to higher breathing frequency. Dead space volume, dead space ventilation, and dead space to tidal volume ratio (VD/VT) were higher in patients with OSA, likely due to a reduction in pulmonary vessel recruitment relative to ventilation. VD/VT decreased more from rest to peak in controls than in patients with OSA, an adaptation that is expected with exercise. Patients with OSA had greater arterial stiffness measured by pulse wave velocity and higher blood pressures, which may have affected cardiac output augmentation. Patients with OSA also had higher resting mean pulmonary artery pressures and exercise dyspnea scores. Regression models predicting peak oxygen uptake and peak work rate were statistically significant, with predictors being age, pulse wave velocity, and resting mean pulmonary artery pressure. The role of diastolic dysfunction remains to be determined.
Prior studies have shown that some effects of OSA on exercise may be reversed with CPAP treatment (Arias, et al. Eur Heart J. 2006;27[9]:1106-1113; Chalegre, et al. Sleep Breath. 2021;25[3]:1195-1202). Understanding the mechanisms of exercise limitation in OSA will help physicians address symptoms, reinforce CPAP adherence, and design tailored pulmonary rehabilitation programs.
Fatima Zeba, MD
Fellow-in-Training
Airways Disorders Network
Pediatric Chest Medicine Section
CPAP for pediatric OSA: “Off-label” use
Pediatric providers are well aware of the “off-label” uses of medications/devices. While it’s not a stretch to apply “adult” diagnostic and therapeutic criteria to older adolescents, more careful consideration is needed for our younger patients. Typically, adenotonsillectomy is first-line treatment for pediatric OSA, but CPAP can be essential for those for whom surgical intervention is not an option, not an option yet, or has been insufficient (residual OSA). Unfortunately, standard CPAP devices are not approved for use in children, and often have a minimum weight requirement of 30 kg. There are respiratory assist devices and home mechanical ventilators that are approved for use in pediatric patients (minimum weight 13 kg or 5 kg) and designed for more complex ventilatory support, and that also are capable of providing continuous pressure. Alternatively, pediatric providers may proceed with the “off-label” use of simpler CPAP-only medical devices and face obstacles in attaining insurance approval. The recent American Academy of Sleep Medicine position statement (Amos, et al. J Clin Sleep Med. 2022;18[8]:2041-3) acknowledges that CPAP therapy can be safe and effective when management is guided by a pediatric specialist and is typically initiated in a monitored setting (inpatient or polysomnogram). The authors bring up excellent points regarding unique considerations for pediatric CPAP therapy, including the need for desensitization and facial development monitoring, lack of technical/software designed for younger/smaller patients, and limited published data (small and diverse cohorts). Ultimately, evaluation of effectiveness and safety, while distinct, must both be seriously considered in this risk-benefit analysis of care.
Pallavi P. Patwari, MD, FAAP, FAASM
Member-at-Large
Pediatric Chest Medicine Section
CPAP for pediatric OSA: “Off-label” use
Pediatric providers are well aware of the “off-label” uses of medications/devices. While it’s not a stretch to apply “adult” diagnostic and therapeutic criteria to older adolescents, more careful consideration is needed for our younger patients. Typically, adenotonsillectomy is first-line treatment for pediatric OSA, but CPAP can be essential for those for whom surgical intervention is not an option, not an option yet, or has been insufficient (residual OSA). Unfortunately, standard CPAP devices are not approved for use in children, and often have a minimum weight requirement of 30 kg. There are respiratory assist devices and home mechanical ventilators that are approved for use in pediatric patients (minimum weight 13 kg or 5 kg) and designed for more complex ventilatory support, and that also are capable of providing continuous pressure. Alternatively, pediatric providers may proceed with the “off-label” use of simpler CPAP-only medical devices and face obstacles in attaining insurance approval. The recent American Academy of Sleep Medicine position statement (Amos, et al. J Clin Sleep Med. 2022;18[8]:2041-3) acknowledges that CPAP therapy can be safe and effective when management is guided by a pediatric specialist and is typically initiated in a monitored setting (inpatient or polysomnogram). The authors bring up excellent points regarding unique considerations for pediatric CPAP therapy, including the need for desensitization and facial development monitoring, lack of technical/software designed for younger/smaller patients, and limited published data (small and diverse cohorts). Ultimately, evaluation of effectiveness and safety, while distinct, must both be seriously considered in this risk-benefit analysis of care.
Pallavi P. Patwari, MD, FAAP, FAASM
Member-at-Large
Pediatric Chest Medicine Section
CPAP for pediatric OSA: “Off-label” use
Pediatric providers are well aware of the “off-label” uses of medications/devices. While it’s not a stretch to apply “adult” diagnostic and therapeutic criteria to older adolescents, more careful consideration is needed for our younger patients. Typically, adenotonsillectomy is first-line treatment for pediatric OSA, but CPAP can be essential for those for whom surgical intervention is not an option, not an option yet, or has been insufficient (residual OSA). Unfortunately, standard CPAP devices are not approved for use in children, and often have a minimum weight requirement of 30 kg. There are respiratory assist devices and home mechanical ventilators that are approved for use in pediatric patients (minimum weight 13 kg or 5 kg) and designed for more complex ventilatory support, and that also are capable of providing continuous pressure. Alternatively, pediatric providers may proceed with the “off-label” use of simpler CPAP-only medical devices and face obstacles in attaining insurance approval. The recent American Academy of Sleep Medicine position statement (Amos, et al. J Clin Sleep Med. 2022;18[8]:2041-3) acknowledges that CPAP therapy can be safe and effective when management is guided by a pediatric specialist and is typically initiated in a monitored setting (inpatient or polysomnogram). The authors bring up excellent points regarding unique considerations for pediatric CPAP therapy, including the need for desensitization and facial development monitoring, lack of technical/software designed for younger/smaller patients, and limited published data (small and diverse cohorts). Ultimately, evaluation of effectiveness and safety, while distinct, must both be seriously considered in this risk-benefit analysis of care.
Pallavi P. Patwari, MD, FAAP, FAASM
Member-at-Large
End the year on a wine note at the final Viva La Vino event of 2022
Don’t miss your last chance to join the CHEST Foundation for a celebration of excellent initiatives – and equally excellent wines – at the last Viva La Vino event of 2022, happening on December 1 at 7 pm.
This event will focus on white and red varietals from Piedmont, a region of Northwest Italy. The Piedmont area is known for producing more wines classified as Denominazione di Origine Controllata e Garantita, the highest classification of quality for wines in Italy, than any other region.
Join CHEST CEO Bob Musacchio, PhD, as he guides attendees through a virtual and interactive exploration of the history, varietals, and techniques of Piedmont wines. Plus, hear from other CHEST leaders and friends of the Foundation about the important work currently being done and the evolution of the Foundation’s many initiatives since its inception.
With their ticket, attendees will receive one bottle of white wine and two bottles of red wine – including Paitin Starda Langhe Nebbiolo 2019, Michele Chiarlo Le Madri Roero Arneis 2020, and Massolino Barbera d’Alba 2019 – as well as an Italian-themed snack kit featuring cheese, salami, taralli, and other tasty treats, to complement their imbibes.
Funds raised from Viva La Vino benefit the Harold Amos Medical Faculty Development Program (AMFDP) and CHEST initiatives to improve patient care. The AMFDP offers 4-year postdoctoral research awards to physicians, dentists, and nurses from historically marginalized backgrounds. Learn more about the recipient of this year’s grant, George Alba, MD, in the September issue of CHEST Physician.
Don’t miss your last chance to join the CHEST Foundation for a celebration of excellent initiatives – and equally excellent wines – at the last Viva La Vino event of 2022, happening on December 1 at 7 pm.
This event will focus on white and red varietals from Piedmont, a region of Northwest Italy. The Piedmont area is known for producing more wines classified as Denominazione di Origine Controllata e Garantita, the highest classification of quality for wines in Italy, than any other region.
Join CHEST CEO Bob Musacchio, PhD, as he guides attendees through a virtual and interactive exploration of the history, varietals, and techniques of Piedmont wines. Plus, hear from other CHEST leaders and friends of the Foundation about the important work currently being done and the evolution of the Foundation’s many initiatives since its inception.
With their ticket, attendees will receive one bottle of white wine and two bottles of red wine – including Paitin Starda Langhe Nebbiolo 2019, Michele Chiarlo Le Madri Roero Arneis 2020, and Massolino Barbera d’Alba 2019 – as well as an Italian-themed snack kit featuring cheese, salami, taralli, and other tasty treats, to complement their imbibes.
Funds raised from Viva La Vino benefit the Harold Amos Medical Faculty Development Program (AMFDP) and CHEST initiatives to improve patient care. The AMFDP offers 4-year postdoctoral research awards to physicians, dentists, and nurses from historically marginalized backgrounds. Learn more about the recipient of this year’s grant, George Alba, MD, in the September issue of CHEST Physician.
Don’t miss your last chance to join the CHEST Foundation for a celebration of excellent initiatives – and equally excellent wines – at the last Viva La Vino event of 2022, happening on December 1 at 7 pm.
This event will focus on white and red varietals from Piedmont, a region of Northwest Italy. The Piedmont area is known for producing more wines classified as Denominazione di Origine Controllata e Garantita, the highest classification of quality for wines in Italy, than any other region.
Join CHEST CEO Bob Musacchio, PhD, as he guides attendees through a virtual and interactive exploration of the history, varietals, and techniques of Piedmont wines. Plus, hear from other CHEST leaders and friends of the Foundation about the important work currently being done and the evolution of the Foundation’s many initiatives since its inception.
With their ticket, attendees will receive one bottle of white wine and two bottles of red wine – including Paitin Starda Langhe Nebbiolo 2019, Michele Chiarlo Le Madri Roero Arneis 2020, and Massolino Barbera d’Alba 2019 – as well as an Italian-themed snack kit featuring cheese, salami, taralli, and other tasty treats, to complement their imbibes.
Funds raised from Viva La Vino benefit the Harold Amos Medical Faculty Development Program (AMFDP) and CHEST initiatives to improve patient care. The AMFDP offers 4-year postdoctoral research awards to physicians, dentists, and nurses from historically marginalized backgrounds. Learn more about the recipient of this year’s grant, George Alba, MD, in the September issue of CHEST Physician.