Hot in CHEST November 2017

By: Dr. Chris Carroll

November 7, 2017

Dr. Chris CarrollEach 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 November, 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.

Straight from a hugely successful CHEST 2017 conference with some really fantastic original science, we have a brand-new CHEST® this month. There are some extremely interesting studies this month, but these three stand out for me!

Hydrocortisone and Vitamin C Synergistically Prevent and Repair LPS-Induced Pulmonary Endothelial Barrier Dysfunction

Dr. Paul Marik is back with a follow-up to his recent, high-profile article in CHEST. This time, Dr. Marik and colleagues looks to provide experimental evidence to support his hypothesis that the combination of hydrocortisone, thiamine, and vitamin C can improve outcomes in patients with sepsis. 

In a new study published in the November issue of CHEST, Dr. Marik and colleagues examined human lung microvascular endothelial cells in vitro and found that the combination of hydrocortisone and vitamin C enhances endothelial barrier function and prevents dysfunction. Interestingly, they found that neither treatment was particularly effective on its own, but together there was synergistic improvement. Might this provide insight to the mechanisms behind his proposed combination treatment? Check out this interesting article for more details!

Hyperbaric Oxygen Delivery for Carbon Monoxide Poisoning

Carbon monoxide exposure is an important public health issue, accounting for thousands of worldwide deaths each year. The use of hyperbaric oxygen therapy has been controversial since the 1920s, in part due to its association with charlatans who advocated and continue to advocate for its utility for a variety of aliments despite lack of scientific evidence of efficacy. For carbon monoxide poisoning, the case series and randomized studies have been mixed. And meta-analyses published in 2005 and 2011 concluded that there were no additional benefits in terms of neurologic recovery when using hyperbaric oxygen therapy compared with 100% normobaric oxygen therapy.

In this issue of CHEST, Huang and colleagues report an analysis from a large database of 25,000 patients in Taiwan who had carbon monoxide poisoning between 1999 to 2013. This study is interesting because it uses mortality as an endpoint rather than neurologic recovery, and it looks at both short-term and long-term recovery across an entire nation. The authors found that the use of hyperbaric oxygen therapy was associated with a lower mortality, even after adjusting for age, sex, underlying comorbidities, monthly income, and concomitant conditions, and especially in patients younger than 20 years and those with acute respiratory failure. Worth a read! And check out Dr. Clayton Cowl’s editorial that gives an outstanding historical context to this study.

Correlation of B-Lines on Ultrasonography With Interstitial Lung Disease on Chest Radiography and CT Imaging

The use of ultrasonography is increasingly popular in pulmonary and critical care medicine, and clinicians are finding more and more uses for this noninvasive and low-risk imaging technology. However, as providers are finding more uses for ultrasound, correlation with more traditional imaging modalities is key. 

In this month’s CHEST, Dr. Dubinsky and colleagues correlated ultrasound findings to chest X-ray and CT scan findings in a cohort of 110 patients with diffuse parenchymal lung disease. Interestingly, the authors found that ultrasound was a good predictor of negative findings in those with diffuse parenchymal lung disease, but the presence of ultrasound findings did not always correlate with chest X-ray and CT findings. These may have been normal variants that were seen on ultrasound. Studies like this are crucial to understanding the implications of our increased use of ultrasound.

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