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Healio Interviews

Disclosures: Carroll and Zielinski are CHEST 2021 co-chairs.
December 21, 2021
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Experts provide top takeaways from the virtual CHEST Annual Meeting

Source:

Healio Interviews

Disclosures: Carroll and Zielinski are CHEST 2021 co-chairs.
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Healio presents highlights from the virtual CHEST Annual Meeting, which was held Oct. 17 to 20.

Our editors spoke with CHEST 2021 Annual Meeting co-chairs Christopher Carroll, MD, FCCP, pediatric intensivist at Connecticut Children’s Medical Center and professor of pediatrics at the University of Connecticut School of Medicine, and David Zielinski, MD, FRCPC, FCCP, pediatric respirologist and associate professor of pediatrics at McGill University Hospital and Montreal Children’s Hospital, Montreal, Quebec, Canada, about their top takeaways from this year’s meeting.

Christopher Carroll
Data were derived from Healio interviews.

Continuing reading for perspective from Carroll and Zielinski.

Editor’s note: All of Healio’s coverage from the CHEST Annual Meeting can be found here .

COVID-19

Carroll: This year at CHEST, we had difficult conversations. Clinicians are hurting as the COVID-19 pandemic continues. CHEST held open forums around broad topics, which were facilitated by a professional counselor and were designed to let people talk about their feelings among peers who had been through it themselves. These sessions were extremely popular, much more popular than we anticipated.

This shows that clinicians really need to talk about their feelings on what has been going on for the last 18 months. I was surprised at the universal themes that emerged. A lot of people were dealing with loss, with the huge volume of patients they see, with other issues related to the pandemic. Many people talked about relatives who are in denial about the pandemic, and how it was very hard for them to go to work all day and care for patients with COVID-19 and then come home and have family members and friends who did not believe it was “real.”

There's an untapped need for physicians to talk with not just physicians, but with other clinicians about their experiences.

Lung cancer guidelines

David Zielinski, MD, FRCPC, FCCP

Zielinski: The meeting featured discussion about the new lung cancer guidelines and different recommendations, including some of the more controversial ones. One of the things I thought was very fascinating is looking at who we should screen. Whenever we're doing screening for lung cancer, there is a balance between picking up too many benign lung nodules and the morbidity and the complications of going after nodules or abnormalities that have no relevance and balancing that against picking up cancer.

A lot of work has been done in trying to identify scoring systems and looking at different risk factors. Sometimes that actually comes against us, and we may miss the individuals who probably have the most benefit from early screening. There are certainly differences based on ethnicity and if you do certain scoring tests with smoking and age, for example, you may actually have less to pick up in African Americans. Even if people don’t meet highest-risk criteria, like smoking history and based on their age, shared decision-making tools that factor in the patient’s values and own opinions should be taken into account in making the choice on screening, which is a bit of a difference from what the way things have had been done before.

Sepsis metrics

Carroll: Also important to mention is a study presented by Sean R. Townsend, MDFCCM, with Sutter Health at California Pacific Medical Center and University of California, San Francisco, and colleagues that looked at the Severe Sepsis and Septic Shock: Management Bundle (SEP-1) metrics, which are reported to CMS, and tied those to mortality in a propensity score matched cohort study. The researchers analyzed patient-level data reported to CMS by 3,241 hospitals over 2 years, specifically looking at the metrics and linking them to mortality in more than 450,000 patients. They reported that compliance with the SEP-1 metrics was associated with lower 30-day mortality.

The reason why this study is interesting is because there has been some resistance to these metrics and questions about their usefulness in the real world; the metrics might only be useful in clinical studies. This study showed that these metrics, and adherence to the metrics, did improve outcomes in a large population of adults.

The COVID-19 pandemic has resulted in a tremendous number of patients with viral sepsis, and so we have treated a lot of sepsis over the last 2 years. This study shows us that these very basic metrics may improve outcomes and show great benefit among this patient population caused by the pandemic and even before the pandemic.

Focus on technology

Zielinski: Another take-home for me is the report from our CHEST Health Policy Advocacy Committee (HPAC). The committee presented their technical reports to CMS to look at how we cover obstructive sleep apnea, hyperventilation, neuromuscular disease and thoracic diseases. A lot of the current coverage by CMS is based on recommendations that are over 20 years old. In that time, the technologies have changed, our knowledge has changed, and the current rules are preventing some individuals to get the equipment they need at the time they need it.

For example, with ventilators, a lot of individuals, whether they have COPD or neuromuscular disease, could benefit starting with simpler bilevel devices, but instead based on current rules receive home ventilators that are up to 10 times more expensive. Other patients who need these more expensive devices struggle to be approved for them. The committee looked at factors that limit access and how best to match the correct device to the correct patient. They made some robust and practical recommendations that we should be following, and these sessions (one pre-recorded and one live) provide and excellent overview of the background and recommendations

For more information:

Christopher Carroll, MD, FCCP, can be reached at ccarrol@connecticutchildrens.org.

David Zielinski, MD, FRCPC, FCCP, can be reached at david.zielinski.med@ssss.gouv.qc.ca.

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