Hot in CHEST May 2017
By: Dr. Chris Carroll
May 9, 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 May, 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 #MayCHEST, or discuss in the CHEST LinkedIn group.
How to Best Provide Long-term Respiratory Support for Children With Spinal Muscular Atrophy
Lead authors: bachjr@njms.rutgers.edu & panitch@email.chop.edu
Spinal muscular atrophy can be a devastating disease. In the most severe cases (spinal muscle atrophy type 1), children require lifelong respiratory support. A tremendous commitment on the part of their caregivers is needed to provide this respiratory support and help with airway clearance, and many of these children receive tracheostomies to aid in these efforts.
However, with improvements in noninvasive support technology, more and more children are being treated for longer and longer with noninvasive support, and some clinicians are advocating that tracheostomies are not needed in this population. However, the pleural of anecdote is not data, and there is not one correct way to treat all children with this disease. In this month’s CHEST, Drs. John Bach and Howard Panitch provide an excellent point/counterpoint discussion that reviews the key issues in this difficult and evolving debate.
Combination Therapy Improves Survival in Influenza A
Lead author: kyyuen@hku.hk
Influenza is the most common vaccine-preventable disease in the United States, and each year approximately 28,000 adults are admitted to an ICU in the United States with influenza-associated critical illness. Treatment is limited to neuraminidase inhibitors, but severe influenza-associated critical illness often presents beyond symptom onset, limiting the usefulness of these medication. In vitro and animal studies have shown that clarithromycin and naproxen may have additive benefit when used in combination with neuraminidase inhibitors.
In a study in this month’s CHEST, investigators sought to determine whether a combination of oseltamivir-clarithromycin-naproxen would have benefit over oseltamivir alone. In this randomized controlled trial of 217 patients with influenza-associated critical illness, combination therapy was associated with reduced 30- and 90-day mortality and length of hospital stay. An intriguing and promising study!
Conducting a Nationwide Observational Clinical Study on Capillary Refill Time Using a “Flash Mob”
Lead author: j.alsma@erasmusmc.nl
Clinical research is time-consuming, and with increasing administrative and financial pressures on physicians, there is less and less time to do clinical research. Recently point-prevalence studies have become an increasingly popular approach to answer clinical questions. These studies ask investigators to only screen and enroll patients on specific days, typically 4 to 6 days over the course of a year. In this month’s CHEST, authors from the Netherlands took this one step further. They used a “flash mob.” The investigators wanted to study interobserver agreement on capillary refill. Assessing capillary refill is something many physicians do multiple times a day, but the authors suspected that the interobserver agreement may not be strong.
In this study design, physicians were recruited to join in this study using word-of-mouth, conventional media, and social media. For 8 hours on one day, physicians were asked to independently assess capillary refill time on the sternum and finger (for 5 and 15 seconds) and to compare that assessment with another independent physician. The study was widely successful with 458 physicians in 38 hospitals enrolling 1,734 patients. The authors found that interobserver agreement was, at best, moderate. And the most reliable assessment was performed on the finger for either 5 or 15 seconds. A novel and effective approach to answering a simple clinical question!