Hot in CHEST July 2017
By: Chris Carroll, MD
July 13, 2017
Each month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's July, so let's hear from Dr. Carroll as he outlines his highlights. After reviewing the issue, be sure to share your hot list on our Facebook wall, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.
Endothelial Permeability and Hemostasis in Septic Shock: Results From the ProCESS Trial
Lead author: Nshapiro@bidmc.harvard.edu
The optimal resuscitation strategy for sepsis is hotly debated, particularly after the recent ProCESS, ARISE, and ProMISe trials. In the current issue of CHEST, Hou et al conducted a post-hoc analysis of the ProCESS data to determine whether there were changes in biomarkers as a result of different resuscitation strategies. The authors examined biomarkers that reflect endothelial cell injury and activation and compared these in those patients receiving early goal-directed therapy a la the Rivers protocol to those who received current standards of care.
They found that there was no effect of the resuscitation strategies on the levels of any of the measured biomarkers. Additionally, they found that regardless of the mode of resuscitation, there was a strong correlation between baseline endothelial markers and mortality rate. These findings suggest that either the different resuscitation strategies were equally effective, or that possibly early and effective resuscitation had no impact on the levels of endothelial injury or coagulation profile over the first 24 hours in septic shock.
IV Magnesium Sulfate for Bronchiolitis: A Randomized Trial
Lead author: dkmaa@hotmail.com
It seems we can’t resist using asthma therapies in children with severe bronchiolitis. When faced with a severely ill child with bronchiolitis, providers may think, “it sounds like wheezing on my exam, so maybe they have bronchospasm that could respond to asthma medications.” But despite initial promise, none of these therapies seem to hold out and we have to re-learn this lesson again and again with albuterol, with epinephrine, with corticosteroids, and now with IV magnesium.
In a trial in this month’s CHEST, 162 children with bronchiolitis were randomized to receive a single dose of 100 mg/kg of IV magnesium in addition to usual care. The primary outcome was time to medical readiness for discharge. There were no significant differences in this primary outcome. However, children who received IV magnesium were significantly more likely to be readmitted to the hospital within 2 weeks (20% vs 6%). This led the authors to conclude that IV magnesium may be harmful in children with bronchiolitis.
Contemporary Reviews in Sleep Medicine: The Impact of Weight Loss Management in Obstructive Sleep Apnea
Lead author: simon.joosten@monashhealth.org.au
Obesity and obstructive sleep apnea (OSA) are common comorbidities that are intrinsically related. In an excellent review in this month’s CHEST, Dr. Joosten and colleagues present an excellent review on the issues related to whether obesity leads to OSA or visa versa. Additionally, the authors provide a nice summary of surgical approaches to obesity and the effects of these surgeries on a patient’s OSA: a worthwhile read for health-care providers, patients, or caregivers!