Journal CHEST®
Three-Year Outcomes of Proximal Hypoglossal Nerve Stimulation in OSA
By Alan R. Schwartz, MD, and colleagues
Proximal hypoglossal nerve stimulation represents a significant advancement in OSA therapy, differentiating itself from distal devices by achieving tongue stiffening, thereby treating a broader patient cohort, including those with complete concentric collapse and wider BMI/apnea-hypopnea index (AHI) ranges.
This study confirms the therapy’s durable efficacy: Three-year outcomes show sustained, clinically significant AHI reductions and quality-of-life benefits that are comparable to established distal stimulation devices. Crucially, the long-term success rate appears maintained. However, interpreting these findings must account for a 25% attrition rate, the limitation of self-reported adherence data, and the potential impact of the open-label design and limited demographic homogeneity on the generalizability of long-term success predictors. Notably, while the median AHI improvement of -17.7 events/hour is substantial, it does not yet match the superior efficacy typically achieved with PAP therapy.
Commentary by Ritwick Agrawal, MD, MS, FCCP, Member of the CHEST Physician Editorial Board
CHEST® Pulmonary
Shared Decision-Making for Lung Cancer Screening
By Adrienne Landsteiner, PhD, MPH, and colleagues
In a recent systematic review, Dr. Landsteiner and colleagues explore tools and strategies used to enhance shared decision-making (SDM) in lung cancer screening (LCS). Although SDM is an integral component of LCS, its documentation is inconsistent and mode of delivery is widely variable. Their overall findings suggest that SDM can increase LCS participation (regardless of tool selected) and does not contribute to decisional conflict/regret. More importantly, this study uncovers the significant variability and limited reports of clinical and patient-centered outcomes. They supported efforts directed toward meaningful SDM delivery within the various clinic environments and consideration of increasing patient-facing modalities. Identification of optimal SDM strategies with a personalized approach may be a key component of improving LCS adherence.
Commentary by Syliva S. Yong, MD, and Saadia A. Faiz, MD, FCCP, Members of the CHEST Physician Editorial Board
CHEST® Critical Care
Reflective Biomarker or Independent Risk Predictor? Assessing Lactate Clearance in Postoperative Cardiac Surgery Outcomes
By Alexandra A. Rizaldi, BA, and colleagues
Rizaldi and colleagues examine an important question in postoperative cardiac surgery care: whether lactate clearance should be considered an independent predictor of poor outcomes or a marker of underlying physiologic risk. In this retrospective cohort, delayed lactate clearance, particularly beyond 24 hours, was strongly associated with operative mortality and major postoperative morbidity. However, lactate dynamics did not meaningfully improve risk prediction beyond already well-established tools such as STS-PROM and early postoperative vasoactive-inotropic score. Lactate remains a valuable bedside signal, but these findings caution against interpreting it in isolation or allowing persistent elevation alone to drive escalation, delayed extubation, or prognostic conclusions. The study supports a more integrated approach: Lactate should inform clinical judgment alongside operative complexity, hemodynamics, vasoactive support, and existing perioperative risk models.
Commentary by Timothy J. Kinsey, DMSc, PA-C, CCAPP, FCCP, Member of the CHEST Physician Editorial Board
