Hot in CHEST March 2017

By: Dr. Chris Carroll

March 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 March, so let's hear from Dr. Carroll as he outlines his highlights. After reviewing the issue, be sure to share your hot list our Facebook wall, tweet with the hashtag #MarchCHEST, or discuss in the CHEST LinkedIn group.

Should Acute Fluid Resuscitation Be Guided Primarily by IVC Ultrasound for Shock? A Point/Counterpoint

Determining fluid responsiveness is an important part of acute fluid resuscitation and a key element in the management of sepsis and septic shock in the new Surviving Sepsis Guidelines. However, the new guidelines do not delineate how to determine fluid responsiveness and instead leave this clinical decision to providers at the bedside.

There are several potential methods for determining fluid responsiveness, and providers disagree about which is best. One potentially attractive method is to examine changes in inferior vena cava (IVC) diameter by ultrasound. In this month’s CHEST, Dr. Schmidt and Dr. Kory discuss the pros and cons of this approach: a hotly debated topic and an excellent discussion of the key issues.

Neuromuscular Blockade in the 21st Century ICU

The use of neuromuscular blocking agents (NMBAs) is controversial in the ICU. In 2002, clinical practice guidelines (developed largely from observational studies) cautioned against their use except as a last resort. But recent prospective and randomized controlled trials have suggested that there may still be populations and indications for the use of NMBA. An article in this month’s CHEST reviews this new evidence and changes in the delivery of critical care that show a more optimistic outlook on the use of NMBAs.

Improving the Management of COPD in Women

More women die of COPD than of breast and lung cancer combined; however, the effects of COPD in women receive little public health attention. Worldwide, the prevalence of COPD in women is surging, and in some countries female COPD-related deaths have surpassed the number in men. There are important gender-related differences in risk, in disease progression, and in outcomes.

Providers should be aware of these differences when managing women with COPD. In this must-read review article in this month’s CHEST, the authors address the urgent need for recognizing and raising awareness of the burden of COPD in women, and discuss strategies for the prevention and treatment of COPD in women.