NetWork Bites: Airway Disorders

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Best Practices: Inhaler Technique Teaching and Assessment

American Association for Bronchology and Interventional Pulmonology: Benign Central Airway Obstruction. Do We Need a Multidisciplinary Approach for This “Benign” Disease?

We will review the most common cause of benign airway obstruction, the complexity of this disorder, and the need for a multidisciplinary team for the best treatment options.

Treatment of Status Asthmaticus

The treatment of status asthamticus is complex and includes optimal delivery of bronchodiolators, noninvasive mechanical ventilation, and corticosteroids. New studies and guidelines have been published to support an evidence-based approach to treating these severely ill patients. Strategies for mechanical ventilation should by based on the physiology of severe obstruction and an indepth knowledge of drugs used for sedation/paralysis is essential. Adjunctive therapy, including ECMO, may be required in patients who fail to respnd to standard therapy. This lecture will address each of these issues and bring the audience up to date on caring for asthma in the ICU.

Society of Thoracic Surgeons: The Ground Glass Lesion. Indolent or Deadly?

Evolving concepts in the definition of the patient with a lung nodule at high risk for complications from interventions will be explored.

Postoperative Management of Cardiovascular Surgery Patients

Management of cardiovascular surgery patients in a quartenary referral center can be quite complex. We intend to discuss the management of hemodynamic complications, specifically vasopegia, bleeding complications, and the management of postoperative pain with the use of ERACS recovery system.

Acute Right Ventricular Failure. Is It the Worst Failure to Have?

Acute right ventricular failure is a rapidly progressive syndrome with systemic congestion resulting from impaired filling and/or reduced flow output. Research efforts have disproportionately focused on the failing left ventricle, but more attention has been placed on understanding the RV. It is a heterogeneous syndrome, and its varied etiologies require individualized treatment. This review will try to identify the efficacy and safety of pharmacological and mechanical interventions for the treatment of acute RV failure, in view of the high morbidity and mortality carried by this overlooked condition.

NetWork Bites: Cardiovascular Medicine and Surgery

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: SCAI Classification of Cardiogenic Shock

Another Respiratory Virus Winter Season?

“This session will explore multiple aspects of respiratory infection from epidemiology through specific seasonal and pandemic viruses, clinical presentation, their role in acute and chronic lung diseases, and treatment and prevention. Respiratory viral infections continue to be a major global health problem affecting all ages, particularly affecting the very young children and elderly populations. Respiratory viruses are the most commonly detected causes of community-acquired pneumonia and respiratory tract infections. Over the past decades, important advances in the understanding of epidemiology and prevalence of these pathogens have emerged and changed the perception of these pathogens. Molecular-based nucleic acid detection has become the standard diagnostic method for respiratory viral pathogens, having replaced older serologic and antigen-detection methods. Current available antiviral therapies for some respiratory viral infections will be described. Finally, preventive strategies, including immunization directed to limited number of respiratory pathogens, will be reviewed”

Tuberculosis: New Challenges and New Therapies in the Era of Drug Resistance

There are an estimated 10 million newly diagnosed cases of tuberculosis (TB) worldwide per year. Of the 500,000 prevalent cases of multidrug-resistant and rifampin-resistant tuberculosis (MDR/RR-TB), nearly half of these patients will die. New therapies and preventive strategies for MDR/RR-TB have the potential to reduce the morbidity and mortality of this disease. In this session, we will review the global epidemiology of MDR/RR-TB, novel methods for disease prevention, and modern strategies for drug therapy, including the repurposed use of older medications for TB treatment as well as novel agents, such as bedaquiline and pretonamid.

Treating NTM lung Infections Based on the 2020 Guidelines

This session will use a case-based approach to illustrate the impact of the new ATS/ISDA guidelines on the treatment of nontuberculous mycobacterial lung infections.

Supported in part by an educational grant from Insmed.

Opportunistic Pneumonias in Immunocompromised Hosts: Understanding the Risk in Non-HIV Patients

Opportunistic infections kill more than 1.5 million people globally each year. Secondary to advances in immunotherapy for various disorders, the number of at-risk, immunocompromised persons is increasing. However, not all immune-modulating medications have the same risk for causing opportunistic infections, and some medications may predispose to different organisms. Moreover pneumonias caused by opportunistic fungi, bacteria, and viruses have a high mortality rate; successful patient outcomes hinge on prevention and early diagnosis. Providers should be aware of the indications for pharmacologic prophylaxis, the types of infections associated with different immune-modulating medications, and the diagnostic limitations caused by pharmacologic prophylaxis.

Supported in part by a continuing education grant from Merck Sharp & Dohme Corp.

Critical Care Year in Review – I

This session will give the learner insights into new developments in sepsis, nonpulmonary critical care, mechanical ventialtion, and respiratory support. This session has been held for several years to an overflow crowd of participants and is a continuation of this annual presentation.

Ventilator Liberation: An Evidence-based Approach

Attendees will learn evidence-based approaches for liberating patients from mechanical ventilation. This session will be based on recommendations published in CHEST guidelines.

Severe ARDS: New Frontiers in Management

Patients with severe ARDS challenge clinicians with their life-threatening illness and the complex strategies required for effective management. Attendees at this session will learn about the most recent research informing clinicians about management options in a case-based approach.

How Do You Say It? The Communication Tightrope in the ICU

Family-centered communication and integrated palliative care in the ICU practice setting can reduce acute stress for families. Structured communication is an important strategy to decrease family distress and the intensity of patient treatment; however, there is a substantial gap in the literature about how to translate communication improvements among the team and with families into clinical practice. The objectives of this session are to explore what is known about ICU communication, discuss the quality of current evidence to support practice, and apply this knowledge to a case study about a challenging end-of-life discussion.

Bundles and Measures: Controversies in Sepsis Care

In recent years, the sepsis literature has evolved significantly: changes to the 3-hour surviving sepsis campaign (SSC) bundle to 1 hour and the creation of the sepsis core measure (SEP-1) and state mandate (New York). The changes to the SSC bundle raised controversy in the sepsis community and its implementation is currently on hold in the United States but not in Europe. The New York and CMS sepsis mandates have shown a positive effect on patient outcomes; however, there is resistance to their nationwide adoption. This session will include two debates from experts in the SSC bundle and core measures.

A Systematic Approach to the Management of Massive Hemoptysis

Massive hemoptysis remain the dreadful situation in clinical medicine that every airway doctor would like to avoid. Time is of the essence, and every second counts when it comes to the management of massive hemoptysis and a systematic approach is key to timely control. In three separate lectures, the presenters will discuss the etiology, stabilization, and management of massive hemoptysis. The goal is to provide the participants with the knowledge base and skill set required to take care of victims of massive hemoptysis.

Toxidromes and Overdose in the ICU Setting

Pattern recognition of toxidromes is important in identifying the agent and effecting timely intervention. Additionally, awareness of the newer agents of abuse, as well as emerging trends in management, may impact upon success in an acute poisoning encounter in emergency. This session will provide an overview of selected toxidromes of particular interest to medical intensive care clinicians.

Vaping-associated Respiratory Disease Syndromes (VARDS)

Exposure to vaping is associated with a growing list of respiratory syndromes, including an acute progressive form with life-threatening hypoxemic respiratory failure and pathological changes of lung injury defining VARDS. The reported spectrum of vaping-associated respiratory diseases allows clinical classification of cases into groups with distinct evaluation, management, and follow-up guidance. Clinical stratification also identifies a small proportion of vaping-exposed patients who are at risk for progression to hypoxemic respiratory failure and an ARDS-like illness.

Post-Code Blues: We Got ROSC! Now What?

Cardiac arrest is a devastating event that requires an immediate, coordinated response to achieve the return of spontaneous circulation (ROSC). The vast majority of clinicians are certified in Adult Cardiac Life Support (ACLS); however, few receive specific training on the rapidly evolving field of care of the post-ROSC patient. While targeted temperature management (TTM) justly receives much attention, optimization of other physiologic parameters may improve the likelihood of good outcomes after cardiac arrest and a thoughtful approach to neurological prognostication is warranted in all comers.

Understanding DO2/VO2 in Shock: Don’t Abandon ScvO2!

We will review the fundamentals of oxygen transport and the balance between DO2 and VO2 in shock. We will discuss the hemodynamic phenotypes beyond vital signs, using endpoints of resuscitation such as ScvO2, lactate, and stroke volume variation. We will review the literature specific to the value of ScvO2 as a hemodynamic target and an outcome prognosticator in critically ill patients. We will share case examples to show the value of targeting ScvO2 at the bedside.

NetWork Bites: Critical Care

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Liberation From Mechanical Ventilation

The Secondary Pulmonary Lobule and High-Resolution Patterns of Interstitial Lung Disease

This session will include a didactic discussion of the high-resolution anatomy of the secondary pulmonary lobule, followed by three clinical case presentations with imaging to reinforce the importance of this functional end unit of the lung for the diagnosis of ILD.

CTD-ILD, Overview of the Radiologic Patterns, Treatment Options, and Transplant Outcome

Among all categories of interstitial lung disease, connective tissue disease-related interstitial lung disease (CTD-ILD) is a complex undertaking that requires a multidisplinary approach by pulmonary, radiology, pathology, and rheumatology physicians. Controversies in the diagnosis, management and prognosis of the variant categories of CTD will be discussed in this session. Recent observations have indicated special radiologic patterns on HRCT that might indicate a connective tissue disease as the underlying etiology for ILD. Finally, treatment options for early detected, refractory, and progresive fibrotic interstitial lung disease will be discussed, including lung transplant outcomes compared to other categries of ILD.

Supported in part by an independent medical education grant from Boehringer Ingelheim Pharmaceuticals, Inc.
Supported in part by an independent medical education grant from Genentech, Inc.

Comorbidities in Interstitial Lung Diseases: An Overlooked Burden

Recent advances in therapeutic options, including the advent of antifibrotic therapies beyond IPF and use of immunosuppressive agents in other ILDs, have led to more purposeful management among these patients. However, treatment benefits seen in pharmaceutical trials are not always applicable to the general ILD population where comorbid conditions significantly affect morbidity and mortality. Strategies for the management of comorbidities associated with ILD are potentially beneficial but the evidence is controversial. This session will involve a diverse group of expert providers discussing current evidence in managing comorbidities such as gastroesophageal reflux, pulmonary hypertension, sleep disordered breathing, and sarcopenia.

Supported in part by an independent medical education grant from Boehringer Ingelheim Pharmaceuticals, Inc.
Supported in part by an independent medical education grant from Genentech, Inc.

Role of Genetics in Pulmonary Fibrosis – Ready for Prime Time?

Pulmonary fibrosis remains a devastating disease with mortality that is often worse than many cancers. There is increasing recognition of the need for clinical practitioners to understand the important role of genetics in pulmonary fibrosis risk, disease progression and the impact on management. In 4 separate lectures, the presenters will discuss genetic risk factors in interstitial lung abnormalities, familial pulmonary fibrosis, implications for lung transplantation, and therapy. The goal is to provide participants with the skillset to improve the management of pulmonary fibrosis and guide personalized therapeutic choices based on current knowledge of genetic risk factors impacting the disease.

Supported in part by an independent medical education grant from Boehringer Ingelheim Pharmaceuticals, Inc.
Supported in part by an independent medical education grant from Genentech, Inc.

What Is Bronchiolitis? A Case-based Discussion for Diagnosis and Management

Bronchiolitis refers to a set of diseases affecting the small airways, which are frustratingly hard to diagnose and manage. Misdiagnosis and treatment delay may result in progressive respiratory decline. Early recognition of culprit drugs, exposures, and systemic disease amenable to immunosuppression are among potential interventions. The objectives of this session are to: 1) Present clinical tools to recognize bronchiolar disorders as the predominant or contributing pathology; 2) Identify the likely etiology through clinicoradiologic correlation; and 3) Appreciate the histopathologic pattern of bronchiolar disorders and the appropriate clinical context to obtain histopathology.

Could My job Be Killing Me? Chronic Lung Disease Due to Occupational Exposure

Publication of the ATS/ERS statement by Blanc (below), recent reports of exposures causing interstitial lung disease (ILD) in dentists and autoimmune ILD in stone fabricators, and numerous studies delineating the impact of job exposures in sarcoidosis, asthma, and COPD suggest that for adult practitioners, an occupational history should be of the utmost importance. Yet integrating occupational health assessments into practice is difficult due to a lack of training and awareness of the scope of the problem. This session will include occupational lung health experts to deliver practical advice on recognition and management of occupational lung disease.

Challenges of Diagnosing and Treating Lung Cancer in ILD

Management of lung cancers with underlying interstitial lung diseases has unique challenges. During this 60-minute session, divided into 4 separate lectures, we will discuss the incidence and epidemiology of lung cancers in this population, the role of biologics and chemotherapy effects, and radiation therapy and associated complications with underlying ILD. In addition, use of genomic classifier and surgical considerations will be covered. The goal is to review the importance of early diagnosis of cancers and discuss common drugs that can both cause or worsen ILD to help guide safe drug choice and recognition of pulmonary adverse effects of these drugs.

Supported in part by an independent medical education grant from Boehringer Ingelheim Pharmaceuticals, Inc.
Supported in part by an independent medical education grant from Genentech, Inc.
Supported in part by a continuing education grant from Merck Sharp & Dohme Corp.
Supported in part by an independent grant from AstraZeneca Pharmaceuticals LP.

NetWork Bites: Interstitial and Diffuse Lung Disease

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Eosinophilic Lung Diseases

NetWork Bites: Disaster Response and Global Health

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Mass Shootings: My Experiences From the San Bernardino Shooting

Persistent Air Leak: Management Approaches for a Community Pulmonologist

Persistent air leaks are a therapeutic challenge for pulmonologists and thoracic surgeons. A multidisciplinary approach is key in the management of these challenging cases. Pulmonologists in nontertiary care centers may often come across such situations, where services of thoracic surgeons and interventional pulmonologists may not be readily available. Moreover, within the US, lack of medical insurance limits many bronchoscopic interventions, which are now the more favored approach in these settings, as a result of which resources are limited in many public county hospitals, a situation similar in many developing countries. This session will involve presentation of three to four such cases encountered in a public county hospital; following which a panel of two to three international experts in pleural diseases will be asked to present their views on management of these cases in resource-limited settings and resourceful settings.

ICU Care Transitions: Patient Movement, Provider Flux, and Communication Challenges

Medical errors are a common cause of death, and care transitions have been identified as a major contributor to medical errors. Research in informatics, human factors, and implementation science supports frameworks and practices for reliable transitions (eg, standardization, active bidirectional communication). While this evidence has been translated into practice for lower-risk transitions (eg, ward shift handoffs), an awareness and implementation gap remains for higher-risk ICU transitions. We aim to increase awareness of this gap and its influence on important outcomes, to provide attendees with systematic approaches for planning and communicating around ICU transitions, and to discuss solutions to these problems.

Pulmonary Procedural Assessment Tools: A Destination Story

This session will involve insturction on how to use several different assessment tools for commonly performed pulmonary procedures. The audience will watch a brief video of a procedure then be instructed on how to use an assessment tool by the faculty. The audience will work in small groups to share and discuss their evaluations prior to the faculty sharing their application of the assessment tools. We will review the Ontario Bronchoscopy Assessment Tool (OBAT) for conventional bronchoscopy, EBUS-STAT for EBUS TBNA, and iCOMPT for chest tubes. If additional time (beyond 60 minutes) is available then we can expand the program.

The “Lost to Follow-up” Epidemic: Impact and Tools You Can Use in Your Practice

“Patient lost to follow-up, that all too familiar cause of treatment plan non-adherence, is a short-hand euphemism for an often multifactorial “”failure to find”” that frequently leads to poor outcomes with substantial emotional and financial impact on patients, clinicians, and health care systems. In this interactive, case-based session, participants will learn the surprising/alarming scale of this problem and walk away with practical guides and tools to identify at-risk patients, communicate with them more effectively, and provide a feasible safety net including, but not limited to, technological solutions.”

How to Get Published: Tips From the Editors

Preparing manuscripts for submission to medical journals is an essential skill in academic medicine. Knowing what to do, and not to do, makes for a more rewarding and productive effort. In this session, editors from a leading pulmonary/critical care journal and a leading general medical journal will discuss what editors look for when evaluating manuscripts, common mistakes made by authors, and tips to avoid them.

Burnedout, MD. Burnedout, RT. Burnedout, NP/PA. Finding Joy in Medicine: Proven Strategies

Burnout is characterized by emotional, mental, and physical exhaustion caused by stress of any kind. Studies have shown that burnout is amongst the worst in medicine, and the subspecialty fields of cardiology, critical care, and cardiothoracic surgery, encompassed by CHEST, are linked to some of the worst burnout rates in medicine. How then do we build resilience into ourselves so we continue to find joy in medicine?

Changing Face of Sickle Cell Disease

Sickle cell disease is a group of inherited red blood cell disorders. People who have sickle cell disease have an abnormal protein in their red blood cells that causes abnormal oxygenation, leading to acute chest syndrome and hypoxic damage to lungs, which can be life threatening. Sickle cell disease can also lead to ischemic heart disease and pulmonary hypertension. With time, there is progressive loss of lung function and increasing thromboembolic risk leading to chronic hypoxemia. It is important to understand disease progression and management of its complications, as with time, it is becoming an adult pulmonary disease.

CHEST-Fleischner Society Presentation: New Lung Cancer Screening Guidelines

• Rationale for revision of LCS guidelines
• Panel discussion: LCS case
• Revised LCS guidelines
• Panel discussion: LCS case
• Introduction

Point-of-care Ultrasonography: Competency, Credentialing, Billing, and Naysayers

Point-of-care ultrasonography (POCUS) is widely used by intensivists and pulmonologists. Across the country, hospitals and hospital systems are being forced to reckon with assessing competency and credentialing clinicians that use POCUS for patient care. Furthermore, many intensivists and pulmonologists have begun to bill for their POCUS examinations, with little guidance available on best practice. This landscape has created a fertile ground for controversy in+D49 all of these areas. This session aims to address these important issues.

POCUS Ultrasound in the Clinic

POCUS has become standard of care for the ICU but has had limited use in pulmonary clinics, where spirometry and 6-minute walks rule the diagnostic procedures. Some pulmonary clinics have found it profitable to purchase an ultrasound for use with thoracentesis, but this is not widespread due to reimbursement. In the work-up for dyspnea, a few minutes with the ultrasound and some focused knowledge and skill in lung, pleural, and cardiac ultrasound can quickly guide further work-up and treatment for pulmonary clinic patients. This panel will illustrate ways to add this skill to a pulmonary practice.

NetWork Bites: Thoracic Oncology

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Shared Decision-Making in Lung Cancer Screening; Incorporating Calculator Tools in the Conversation

American Association for Bronchology and Interventional Pulmonology: Multidisciplinary Approach to Trapped Lung Syndrome. When Should We Intervene?

What is the meaning of trapped lung and is there anything we can do as physicians to prevents its development?

American Association for Bronchology and Interventional Pulmonology: Non-surgical Treatment of Stage I Lung Cancer. What Works?

“The standard of care for stage I non-small cell lung cancer (NSCLC) is lobectomy with lymph node dissection. Radiation is standard treatment for patients who cannot tolerate surgery. But are there any other options, such as ablative therapies?”

Eligibility, Dissemination, and Access to Lung Cancer Screening: Challenges and Opportunities

Annual lung cancer screening (LCS) is one of the few public health interventions proven to reduce lung cancer mortality, yet utilization and implementation remain overburdened by barriers, including how best to select high-risk individuals and how to improve access to high-quality screening. There is concern that disparities in implementation of and access to LCS will further widen the disparity gaps that occur in lung cancer. Three separate lectures will review current disparities in LCS eligibility and access and explore strategies to improve selection and access. The goal is to provide participants with the knowledge to promote equitable LCS.

Supported in part by a continuing education grant from Merck Sharp & Dohme Corp.
Supported in part by an independent grant from AstraZeneca Pharmaceuticals LP.

Addressing an Invisible Epidemic: Lung Cancer in Women

Lung cancer in women is a modern epidemic and a major global health crisis. Cigarette smoking remains the most important risk factor but lung cancer in nonsmokers is more common among women and data points to sex differences in the biology of lung cancer. The benefits of lung cancer screening were significantly greater in women on the NELSON trial. However, current screening criteria identify fewer women than men who develop lung cancer. Continued attention must be paid to sex differences in lung cancer risk, screening criteria, and treatment outcomes, and the impact of this disease on women’s health issues.

Supported in part by a continuing education grant from Merck Sharp & Dohme Corp.
Supported in part by an independent grant from AstraZeneca Pharmaceuticals LP.

Controversies in Indwelling Tunneled Pleural Catheter Management

“The management of recurrent pleural effusions remains a challenging issue for clinicians. Advances in management have led to increased use of indwelling tunneled pleural catheters (IPC) due to their effectiveness and ease of outpatient placement. However, with the increase in IPC placement, there have also been increasing reports of complications, including infections. Currently there is minimal guidance in IPC-related management issues after placement. This session will involve pro/con discussions around two key areas of controversy: 1) IPC drainage schedule recommendations and 2) Management of IPC-related infections.”

ROSE It Yourself

FDG avid mediastinal adenopathy whether related or unrelated to a primary lung lesion, is not an uncommon radiographic finding. This case-based presentation involving an expert interventional pulmonologist, radiologist, pathologist and infectious disease physician, will guide the practitioner through various clinical paths and outcomes in patients with mediastinal disease. The demonstration of optimal endoscopic techniques as well as the utility of rapid onsite cytopathologist evaluation (ROSE) will be discussed.

Supported in part by a continuing education grant from Merck Sharp & Dohme Corp.
Supported in part by an independent grant from AstraZeneca Pharmaceuticals LP.

Asthma and Women: Through the Lifespan

One in 13 people in the United States have asthma, and prevalence of asthma in women 18 to 44 years of age has increased in the last 15 years. Sex-related differences in asthma prevalence are well established and change through the reproductive phases of life. By puberty, prevalence of asthma starts to change and it is more frequent in women during adulthood. Fluctuations of hormones during puberty, menstruation, pregnancy, and menopause alter asthma symptoms and severity. Understanding these differences is key to suspecting, diagnosing, and managing asthma through various stages of a woman’s life.

The Significance and Management of Excessive Dynamic Airway Collapse: A Pro/Con Debate

Excessive dynamic airway collapse (EDAC) is often noted during bronchoscopy, but what is it, what percent of collapse clinically matters, and should you treat it? This session will focus on the controversies regarding the diagnosis, significance, and potential management of EDAC, including tracheoplasty. The audience response system will be used to allow the audience to participate within the debate.

NetWork Bites: Women’s Lung Health

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Nature vs Nurture: Lifelong Consequences of Inhalational Exposures”

NetWork Bites: Palliative and End-of-Life Care

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Words to Say When We “”Don’t Know What to Say””: Language and Word Choice in the ICU

What’s New in Pediatric Asthma

The approach to severe problematic asthma in children requires a coordinated pharmacological and, more importantly, nonpharmacological paradigm to care. This session will review the medical management of problematic asthma in children, and examine how best to care in an interdisciplinary manner and create a clinic to manage these children. Recent recommendations from guidelines, including GINA 2019, and how they pertain to children will also be reviewed.

NetWork Bites: Pediatric Chest Medicine

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: COVID-19 in the Pediatric Age Groups

NetWork Bites: Interprofessional Team

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Interprofessional Team and Noninvasive Ventilation

NetWork Bites: Interventional Chest/Diagnostic Procedures

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Bronchoscopy in a Time of a Pandemic: Best Practices and Controversies

Anesthetic Considerations in Bronchoscopy – View From the Pulmonologist’s Standpoint

Pulmonologists seem divided about the optimum anesthetic modality for bronchoscopic procedures. This is largely a result of practice preference and available infrastructure at their institutions. Practice patterns are influenced by evidence behind use of a specific anesthetic modality or pressure stemming from an institution’s understanding of resource utilization. The session will inform the audience with evidence-based information needed to optimize their practice or make a case for advanced anesthetic support. Anesthetic considerations for therapeutic bronchoscopy will also be discussed.

Targeting the Periphery of the Lung: The Final Frontier

New technologies and approaches to peripheral lung nodule diagnostics are being introduced at an increasing rate. In order to assist attendees’ understanding of the true definition of diagnostic yield and its importance in lung nodule biopsy in the periphery of the lung, this session will provide an evidence-based review and assessment of the current literature and controversies surronding diagnostic yield in bronchoscopy. Case-based examples highlighting specific advances in peripheral bronchoscopy will be disussed. Active audience participation will be encouraged- with ample question- and answer-focused material.

Pulmonary Manifestations of Hematologic Malignancies: A Case-Based Overview

Pulmonary disease can occur across the entire disease spectrum of hematologic malignancies, presenting as a lung mass, a malignant pleural effusion, lymphadenopathy, or superior vena cava syndrome. The diagnosis of these malignancies can be challenging, and hematologic aberrancies and immunosuppression may complicate management. In this session, three different case-based scenarios will highlight pulmonary manifestations of hematologic malignancies.

NetWork Bites: Pulmonary Physiology Function and Rehabilitation

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: A Novel Spirometric Tool: Area Under Expiratory (AEX) Flow-Volume Curve

Field Tests – Assessing Activity Limitation

“Activity limitation is a cardinal finding in medicine, and a frequent symptom of individuals assessed by clinicians. Objective evaluation of activity limitation assists both with its evaluation and in determining etiology. While several modalities are available for use, there is genuine uncertainty regarding the best test for different purposes, as well as regarding practical conduct and interpretation in various clinical settings. This session will review objective reasons for assessing activity limitation, and discuss different methods for varying purposes. Using a case-study approach, practical guidance for the selection, conduct, and interpretation of activity field testing in clinical practice will be provided. “

Challenges of Air Travel in Patients With Pulmonary Disease

Approximately 4.23 billion passengers worldwide ( >1 billion US) travelled by air in 2018.The hypoxic and hypobaric aircraft cabin can lead to exacerbation of chronic cardiopulmonary disorders. Respiratory symptoms accounted for 12% of in-air emergencies, are the third most-frequent cause for aircraft diversion, and are an increased risk of hospitalization post-flight. There’s also increased risk of venous thromboembolism and potential communicable diseases transmission due to relative immobility and proximity of passengers, respectively. This session familiarizes the audience with flight physiology, preflight risk stratification of patients, and disease-specific air travel recommendations. Medical resources available in-flight and practical considerations for managing in-flight medical emergencies are also discussed.

Pulmonary Rehab: Where We’re At and Where We’re Going

This session will focus on recent developments in pulmonary rehabilitation (PR), centered on improving outcomes not only during active participation in PR, but maintenance of those gains following PR completion. Further, the referral rate for PR is extremely low and many patients with COPD may be unaware of its existence despite having a high symptom burden. Unfortunately, this problem is worsened by PR program availability and proximity issues – and this session also will include a discussion on improving the availability and accessibility of this extremely important treatment modality.

Supported in part by an independent educational program from GlaxoSmithKline LLC.
Supported in part by an independent medical educational grant from Mylan Specialty L.P.

Controversies in the Management of Intermediate and High-Risk Pulmonary Embolism

Risk stratification and treatment options for patients with intermediate-high (submassive) and high (massive) pulmonary embolism has continued to evolve. Recently published guidelines stress the importance of severity assessment and risk-adjusted approaches to management. One area of particular interest in recent years is the utilization of pulmonary embolism response teams (PERT) to guide the managment of these complex patients. Another evolving area of controversy is the optimal use of mechanical circulatory support in acute PE-associated shock or cardiac arrest. This session will include two pro/con debates surrounding these issues.

Too Much of a Good Thing or Not Enough? Treating Scleroderma With ILD and PH: A Pro-Con Debate

Current guidelines advise treatment for pulmonary arterial hypertension (PAH) but not interstitial lung disease- (ILD-) associated pulmonary hypertension. Patients with scleroderma often present with both, and while targeted therapy may improve PAH, it may be harmful in ILD, and the optimal treatment strategy is unclear. Using a Pro-Con debate format, this session fulfills the needs of cardiac and pulmonary practitioners in reviewing the management of patients with mixed PAH and ILD. At the conclusion of this session, participants will appreciate the risks and benefits in treating these patients, and be able to apply this knowledge to their own clinical practice.

Supported in part by an independent medical education grant from Boehringer Ingelheim Pharmaceuticals, Inc.
Supported in part by an independent medical education grant from Genentech, Inc.
Supported in part by an educational grant from Bayer HealthCare Pharmaceuticals Inc.
Supported in part by an educational grant from United Therapeutics Corporation.

Is My Patient’s Pulmonary Hypertension Left or Right? The Probe and the Catheter Come to Your Rescue

Group 2 pulmonary hypertension (PH) is the most common type of PH. Also known as PH due to left heart disease, it corresponds to elevation in pulmonary pressures through a retrograde pressure increase from left heart chambers and valve disease. Pulmonary manifestations of left heart disease accounts for a significant number of patients being evaluated for PH and dyspnea of unknown origin. Comprehensive echocardiographic and right heart catheterization assessment is frequently needed to adequately exclude (or confirm) the presence of left heart-associated PH. Key points will be provided to get the most value from those two diagnostic tests.

Supported in part by an educational grant from Bayer HealthCare Pharmaceuticals Inc.
Supported in part by an educational grant from United Therapeutics Corporation.

NetWork Bites: Pulmonary Vascular Disease

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Diastology for the Pulmonologist: What They Didn’t Teach You in “Pulmonary School”

Compassionate Extubation: Many Parts to One Common Goal

Compassionate extubation is a common and complex interdisciplinary process, which allows a patient to be relieved of life-sustaining therapies and transition peacefully. Ethics, symptom management, counseling, and self-care are all important components of this process. In this session, an interprofessional panel, including physicians, a respiratory therapist, and a chaplain, will detail some of the considerations and challenges surrounding compassionate extubation. The multidisciplinary perspective will be highlighted, as well as ways to recognize, prevent, and treat compassion fatigue and burnout in yourself and your colleagues.

Bridging the Gap: Pediatric to Adult Transition for Home Mechanical Ventilation

Medical advancements are allowing children with chronic respiratory failure to live into adulthood. This growing population necessitates adult providers with expertise in home mechanical ventilation who can address the unique needs of this vulnerable patient population. Most academic medical centers have no formal transition process for patients on home mechanical ventilators. Four panel experts will discuss the various components of a formal transition program, including barriers, timing, patient/family preparation, multidiciplinary approach, psychosocial care, and integration of young adults into adult care.

NetWork Bites: Respiratory Care

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Cuff Pressure Measurement in the PICU

“All That Wheezes Is Not Asthma”: A Focus on Structural Asthma Mimickers

General pulmonologists often encouter patients referred for evaluation of difficult-to-control asthma due to persistent wheezing refractory to bronchodilators. The focus of this session is to discuss entities that can mimick asthma due to persistent wheezing, with an emphasis on when to suspect an alternate diagnosis and presenting cases to discuss frequently encountered clincal scenarios (inducible laringeal obstruction, tracheobronchomalacia, and benign central airway obstruction).

NetWork Bites: Sleep Medicine

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: COVID and Your Sleep Practice: Strategies for Management

Understanding the Intricacies of OSA Overlap Syndromes: A Case-based Approach

This evidence-based session will discuss the care of patients who have other pulmonary comorbid conditions in addition to obstructive sleep apnea syndrome. Case-based discussion will focus on key clinical findings, differential diagnosis, and potential pitfalls. Topics will range on a broad range of chest diseases, including obstructive lung disesase, pulmonary fibrosis, and pulmonary hypertension. Topics will be relevant to trainees, generalists, and specialists alike. At the conclusion of this course, learners will have increased knowledge about OSA overlap syndrome and will be able to apply this knowledge to respective practices.

Sleep in Older Adults: What’s Normal, What’s Not, and Why Does It Matter?

The aging process is associated with changes in sleep quality, sleep architecture, circadian rhythms, and sleep disorders, including insomnia. This session will highlight three important topics related to sleep medicine in the elderly, including whether and when to treat sleep-disordered breathing, management of insomnia, and emerging research linking sleep disturbance to development of neurocognitive dysfunction and dementia.

Recognizing and Reducing the Impact of Sleep Apnea After Acute Stroke

Obstructive sleep apnea (OSA) is an independent risk factor for ischemic stroke. New data in the past year has shown that use of CPAP in the acute stroke setting can improve short-term and long-term neurologic outcomes. Innovative strategies are therefore now being proposed to incorporate this potentially practice-altering finding. The aim of this session is to discuss the why, how, and when of diagnosing and treating OSA after acute ischemic stroke.

Improving Sleep Quality for Hospitalized Patients

This session is on sleep quality for in-patients, looking at three settings: 1) gen-med floor, 2) ICU, and 3) LTAC. Dr. Arura is a hospitalist who published the ‘SIESTA’ study, which improved sleep in gen-med in-patients. Dr. Kamdar is an intestivist who can review his data on the role of sleep quality in reducing delerium. Lastly, Dr. Laghi is a sleep medicine physician who can present data from an LTACH on sound masking to improve sleep. At the end of each talk, the lecturer will review real-wolrd strategies to improve sleep quality for in-patients.

Sleep and Substances: From Caffeine to Marijuana

Caffeine, alcohol, melatonin, and OTC preparations containing diphenhydramine are some commonly consumed preparations that patients use to treat their sleep disturbances. The newest legally available agent is marijuana. This session will be an evidence-based discussion on the effect of these agents on sleep and pitfalls with their use. We will also discuss the effect of opioids on sleep and sleep disorders in light of the ongoing opioid epidemic. As providers, we are likely to see some of these patients in our clinics who may not disclose their drug use.

Sleep Pearls for the Pulmonary Provider

Patients with chronic pulmonary disease often have comorbid sleep disorders or nocturnal hypoventilation. The goal of this session is to help general pulmonary providers successfully screen for and manage sleep disorders. First, we will discuss indications for sleep testing in patients with asthma, COPD, pulmonary hypertension, and ILD. Next, we will provide an evidence-based update on strategies for improving CPAP adherence. Finally, the role of noninvasive ventilation for patients with COPD will be explored, including practical strategies for+D140 succesful approval of devices in this population.

Perioperative Management: OSA, COPD, Neuromuscular Disease and Pregnancy

With the ever-increasing medical complexity of patients, there are evolving risks associated with surgical procedures. This is is especially notable in patients with OSA, COPD, and neuromuscular diseases. These comorbidities add increased risks and complications. Proper knowledge of the risks and treatment options in the perioperative period is especially important. In addition to surgical procedures, there are increased needs associated in people living with neuromuscular disease and pregnancy. This session will address pre, peri and post operative evaluation and management strategies.

Night Time Is the Right Time to Study Your Patient’s Oximetry and PAP Data! Adults and Pediatric.

Nocturnal oximetry and PAP downloards are not used as often as they could be to help optimize patient care. For patients with underlying lung disease such as COPD, ILD, etc, exercise oximetry is often done in the office but nocturnal oximetry is rarely utilized. People with normal lung function have reduced FRC and TV during sleep, so for those with underlying lung disease, the hypoventilation can and often is more significant. For patients with known sleep-disordered breathing, PAP downloards can be very useful to identify problems and how best to optimize treatment.

Sleep M&M Cases – Wild Nights, Misadventure, and Educational Opportunities

The Sleep laboratory at night can be an underappreciated source of consternation. Sleep fellow trainees come from diverse specialty backgrounds and experience handling nighttime emergencies. During laboratory-based polysomnography, patients are monitored by technicians (not providers) with little if any training or experience in identifying and managing medical emergencies. This scenario is very different from a hospital ward with on-site providers (nursing, physicians). Fortunately, emergency events, such as cardiac arrest and generalized seizure, are exceedingly rare. However, other events, such as cardiac telemetry abnormalities, adverse medication reactions, and disorderly conduct, may lead to emergencies that require rapid intervention.

E-cigarettes, Marijuana, and Hookah

Use of e-cigarettes, marijuana, and hookah have markedly increased in popularity throughout the world. This session will discuss the impact of these recreational activities on lung health and share clinical pearls on how to discuss these issues.

NetWork Bites: Clinical Pulmonary Medicine

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Taking Action in the Youth Vaping Epidemic

NetWork Bites: Transplant

NetWorks are the 22 special interest groups of CHEST. Each has recorded a bite-sized presentation focused on a hot topic within their area of focus.
Title: Pregnancy After Lung Transplant

Pleural Complications in Lung Transplant Recipients: Outside the Box!

Presence of preexisting pleural disease is an important consideration for lung transplantation. Additionally, pleural complications are common post lung transplantation due to invasion of the pleural sac and as a results of systemic manifestation of immunosuppression, malignancy, and rejection.

Immunosuppressed and in The ICU : What Am I to Do?

This 60-minute session highlights the Intensive Care unit needs and care in three organ transplantation populations: liver, lung, and bone marrow transplants. Managing these patients requires some knowledge related to the underlying disease, related treatments (patterns of toxicity, alternative regimen), specific emergencies (ie, tumour lysis syndrome, cytokine releasing syndrome, or acute humoral rejection), or specific clinical vignettes (febrile neutropenia). This session will address some of the specifics of each of these issues in three different transplant popluations admitted to the ICU. In addition, this session will address which patients will not benefit from ICU care.