CHEST Physician
-
Making invisible problems visible
For Erika Mosesón, MD, a pulmonologist and ICU doctor, advocacy for clean air and climate action started small: signing petitions and writing letters. Even as she attended conferences and learned about the health impacts of air pollution, her impression was that experts were handling it. “I didn’t really think my voice was worth highlighting,” Dr.…
-
The pendulum swings in favor of corticosteroids
The pendulum swings in favor of corticosteroids and endorses the colloquialism among intensivists that no patient shall die without steroids, especially as it relates to sepsis and septic shock. In 2018, we saw divergence among randomized controlled trials in the use of glucocorticoids for adults with septic shock such that hydrocortisone without the use of…
-
Fighting for fresh air: RSV’s connection to environmental pollution
Poor air quality has numerous health hazards for patients with chronic lung disease. Now mounting evidence from pediatric studies suggests a concerning link between air pollution and viral infections, specifically respiratory syncytial virus (RSV). Multiple studies have shown increased incidence and severity of disease in children with exposure to air pollutants such as particulate matter…
-
Is it time to embrace a multinight sleep study?
Since the 1960s, sleep researchers have been intrigued by the first-night effect (FNE) in polysomnography (PSG) studies. A meta-analysis by Ding and colleagues revealed FNE’s impact on sleep metrics, like total sleep time and REM sleep, without affecting the apnea-hypopnea index, highlighting PSG’s limitations in simulating natural sleep patterns.1 Lechat and colleagues conducted a study…
-
Transesophageal ultrasound: The future of ultrasound in the ICU
Historically, transesophageal ultrasound (TEE) has been regarded as a diagnostic and management tool for structural heart disease in relatively stable patients. However, TEE is more commonly being utilized by intensivists as a first-line tool in the diagnostics and management of patients in the ICU. TEE, with its unobstructed superior cardiac views, facilitates rapid diagnosis in…
-
Home ventilation consult
Philips Respironics released a public statement on January 25, 2024, that would dramatically change the landscape of home mechanical ventilation and sleep-disordered breathing management in the United States. The company announced that, effective immediately in the US and US territories, Philips Respironics would stop production and sale of all hospital and home mechanical ventilation products,…
-
Can VAP be prevented? New data suggest so
Ventilator-associated pneumonia (VAP) is a common cause of hospital-related morbidity in critically ill patients. The efficacy of prophylactic antibiotics in the prevention of VAP has been the subject of several studies in recent years. Three large randomized controlled trials, all published since late 2022, have investigated whether antibiotics can prevent VAP and the optimal method…
-
Getting ready for Boston: A look into the CHEST 2024 Scientific Program Committee meeting
A quality educational meeting starts with a great slate of programs tailored to its audience, and CHEST 2024 is on track to offer the highest tier of pulmonary, critical care, and sleep medicine education that attendees have come to expect from the CHEST Annual Meeting. While planning for the meeting started with the open call…
-
Eradicating uncertainty: A review of Pseudomonas aeruginosa eradication in bronchiectasis
Bronchiectasis patients have dilated airways that are often colonized with bacteria, resulting in a vicious cycle of airway inflammation and progressive dilation. Pseudomonas aeruginosa is a frequent airway colonizer and is associated with increased morbidity and mortality in cystic fibrosis (CF) and noncystic fibrosis bronchiectasis (NCFB).1 Both CF and NCFB guidelines recommend eradication of P.…
-
Complexity of hemodynamic assessment in patients with cirrhosis and septic shock
In patients with decompensated cirrhosis, there are multiple intrahepatic and extrahepatic factors contributing to hemodynamic alterations at baseline, including endothelial cell dysfunction, hepatic stellate cell activation promoting increase in vasoconstrictors, decrease in vasodilators, and angiogenesis leading to worsening of portal hypertension. Increased resistance to hepatic blood flow leads to increased production of nitric oxide and…
