Hot in Journal CHEST: October 2020
By: Divya C. Patel (@divyacpateldo)
October 13, 2020
Each month, we ask our Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It's October, so let's hear from co-editor, Dr. Patel, as she outlines her highlights. After reviewing the issue, be sure to share your hot list on our Facebook, tweet with the hashtag #journalCHEST, or discuss in the CHEST LinkedIn group.
I would like to take a minute to highlight CHEST Annual Meeting 2020, the premier educational event of the American College of CHEST Physicians. This year it has gone completely virtual. That means you’ll have the opportunity to reconnect with your colleagues, interact with experts in your field, and hear about cutting-edge research—all from the convenience of your own home or institution.
And if you’ve never been able to attend due to geographic restrictions, now’s your chance—you can join in any location, at any time. I hope to connect with my readers at CHEST 2020 (virtually)!
Here are just three articles from this month’s journal CHEST® that piqued my interest.
Airway clearance techniques (ACTs) are used in order to improve quality of life, reduce exacerbations, and reduce symptoms in patients with non-CF bronchiectasis. The data supporting guideline recommendations for ACT are weak, so the authors of this study aimed to study the clinical outcome of patients with bronchiectasis and chronic cough who were performing ACTs and to compare them with those who were not. They were specifically interested in exacerbation and hospitalizations. A registry consisting of 16 institutions in the United States entered data into the registry. Patients were stratified by continuous use, intermittent use, and no use of ACTs. At baseline, 59% used ACTs, and of these patients, those who continued to use ACTs at follow-up had greater risk for exacerbation, hospitalization for respiratory issue, and infection of Pseudomonas aeruginosa in the prior 2 years. However, 58% of patients using ACTs at baseline were no longer using it at follow-up, and there was no difference in lung function between the groups at follow-up. I think the results reflect the fact that patients with more severe bronchiectasis and symptoms are prescribed ACTs more often.
Cytokine release syndrome (CRS) antagonists such as tocilizumab are typically used for CRS caused by chimeric antigen receptor T-cell infusions. They have been repurposed to treat COVID-19, but their exact role is unclear. This is an observational study in which the authors wanted to determine the role of tocilizumab in hospitalized patients with COVID-19. A retrospective, observational study was performed at one tertiary care center in the United States for 20 days with greater than 3 weeks follow-up. Severe disease was defined as those requiring greater than or equal to 3 L of oxygen to maintain an oxygen saturation of 93% or mechanical ventilation. Both patients with severe and patients with nonsevere COVID-19 received tocilizumab. Out of 239 consecutive patients with COVID-19, 44% met the criteria for severe disease. Ninety percent of patients with severe disease and 40% with nonsevere disease received tocilizumab, but survival was not different between these groups. In treated patients, patients had higher than expected survival.
Spontaneous breathing trials (SBTs) can aid in preventing postextubation failure. Guidelines recommend SBT with a pressure support ventilation (PSV) trial rather than a T-piece trial, but the strength of evidence for this guideline is weak. Studies show that in a real-world setting, T-piece trials are used more frequently than PSV trials. In this study, the authors aimed to determine whether in patients at high risk for reintubation, with standardized oxygen supplementation after extubation, initial SBT with PSV trials hastens extubation compared with T-piece trials. Specifically, this study was a post hoc analysis of a multicenter RCT comparing high-flow nasal cannula oxygen alone vs combined with noninvasive ventilation. Of the 641 patients in the original study, 62% were extubated using PSV and 38% using T-piece. The study showed that performing SBT using PSV in patients at high risk for extubation failure was independently associated with successful extubation compared with a T-piece.
