Home CHEST Thought Leaders Hot in CHEST October 2017

Hot in CHEST October 2017

By: Dr. Deep Ramachandran

Deep Ramachandran 2017Each 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 October, so let's hear from Dr. Ramachandran 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.




From the “I didn’t know this was a controversy” department.

In the current political climate in the United States, the term “brain dead” seems to be thrown around quite a lot these days. Medical professionals, of course, know that there are specific criteria that must be met in order meet the definition of brain death. What many of you may not know, however, is that there is a controversy over whether informed consent should be required before the determination of brain death. In this Pro-Con debate, the contrarian view submits that apnea testing can be harmful, and physicians need to be mindful of minority religious beliefs that do not accept that brain death is an acceptable means to separate the dying from the dead.

A Call to Action to for COPD.

Discussions around COPD have become increasingly relevant in the health-care debate. When you account for the fact that COPD is now the third leading cause of death in the United States, and that more women than men are now dying of this disease, it’s increasingly clear that we need a plan. The NHLBI has thus come up with the COPD National Action Plan. Goals for the COPD National Action Plan include improving prevention, diagnosis, treatment, as well as empowering patients. Check out the elements of the plan here to learn how you and your patients can be a part of this important movement.

Update in severe hypoxia: From ARDS to Zeep.

I love this article. Thorough yet concise, it’s like a handy user’s guide to managing your ventilated patient with severe hypoxia. The article walks through various different rationales for recruitment maneuvers, high vs low peep, ECMO, neuromuscular blockade, and includes exhaustive literature references for you to do a deep dive on particular topics. Full disclosure, they don’t actually talk about zeep, but I couldn’t help myself, that title was just too catchy!

One of the first studies leveraging “Engagement Science”

“What is engagement science”, you ask? It has nothing to do with getting hitched (ugh, that was terrible, right?). Rather, engagement science revolves around the desire to make future clinical trials more patient-centered. This has the potential to make future research more relevant to patients and also to perhaps improve patient recruitment in clinical research, which has been lagging in recent years. To that end, the FAST trial, a trial of ventilator weaning, created a Patient and Family Advisory Committee. This unique committee is made up of ICU survivors and family. Not only has the committee had a hand in trial design, but its members have important functions on other committees, as well. Take a close look at this article and see how they incorporated patient and family input into the trial and realize that you are likely looking at the future of clinical studies in the United States.

Are you billing for conscious sedation?

Many physicians perform bronchoscopy and provide their own sedation services, thus, freeing up our anesthesia colleagues to perform their essential, um “gas passing” duties elsewhere. Charging for these services was often bundled into the bronchoscopy procedure code, and, thus, billing for this conscious sedation administration and monitoring was often confusing. Well, don’t worry, it’s still confusing! But at least wRVU’s for bronchoscopies are going down by 0.25 in 2017. Oh wait, that’s bad news. So, where’s the good news? If you provide your own conscious sedation, you can make up the 0.25 by billing code 99156 for the initial 15 minutes, and go even-steven. Take a look at this article to see the 2017 changes. Send your thank you’s written on the back of a vintage Fender Stratocaster sent to CHEST marked “Deep’s office” #CarTalkForever.