The 84th Annual Meeting of the American College of Chest Physicians

The annual meeting of the American College of Chest Physicians was held from Oct. 6 to 10 in San Antonio and attracted approximately 6,000 participants from around the world, including specialists and heath care professionals focused on pulmonary, critical care, and sleep medicine. The conference featured presentations focusing on clinical updates and advances in chest medicine.

In one study, Alexander Chen, M.D., of the Washington University School of Medicine in St. Louis, and colleagues performed a feasibility assessment of robotic technology in cadaver lungs to see if bronchoscopists using the system could precisely access and biopsy artificial tumor targets that had been placed to closely mimic pulmonary nodules.

“Using this cadaveric model, the robotic system was successful at biopsying 97 percent of nodules,” Chen said. “It is early to jump to conclusions about the impact on clinical practice since this study was performed in cadavers and not live humans. This was a necessary step moving this technology forward and the results are encouraging. We are in the process of performing additional studies in live human subjects to further explore this technology.”

Abstract

In another study, Hira Iftikhar, M.D., of the Beaumont Health System in Royal Oak, Mich., and colleagues evaluated bacterial pathogens in patients with interstitial lung diseases (ILD).

“Infection has been theorized to play a part in not only the disease progression but also acute exacerbations in ILD patients,” Iftikhar said. “However, there is a scarcity of data regarding bacterial pathogens in ILD patients.”

The investigators found a majority of the respiratory isolates were gram-negative pathogens in ILD patients. Gram-negative pathogens were associated with worse outcomes, including worse mortality, higher vasopressor use, and intensive care unit (ICU) admission. These findings were in comparison with methicillin-resistant Staphylococcus aureus, pseudomonas, and other gram-positives.

“We also found that multidrug-resistant pathogens had worse outcomes. Patients who were on immunosuppressants, antifibrotics, or steroids did not have higher rates of multidrug-resistant pathogen isolation,” Iftikhar said. “Given that gram-negatives had worse outcomes in ILD patients, we should consider the type of bacteria while prognosticating patients with ILD.”

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Bobbie Ann Adair White, Ed.D., of Texas A&M University in Temple, and colleagues created and implemented a conflict management education intervention for ICU workers (physicians, nurses, respiratory therapists, and advanced practitioners).

“The intervention’s objectives were around the ideas of ‘diagnosing’ conflict, recognizing internal dialogue, and building awareness through the use of the Thomas Kilmann Inventory, clinical cases, as well as a perception exercise,” White said.

The investigators found that the conflict management education session improved ICU team knowledge.

“Participants were interested in information assisting with conflict resolution, and some participants recognized that mindfulness and awareness would improve professional interactions,” White added. “A specific clinical implication was the finding that the most common conflict management modes in this sample (participant preference for how to handle conflict) were avoiding and compromising, both of which do not yield the best outcomes in conflict, but instead may promote organizational silence. Also of note, the competing mode was least preferred, so it may be advisable to coach staff on how to compete in a healthy way for situations such as fighting for a specific treatment or speaking up to prevent medical errors.”

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Jose A. Rojas-Suarez, M.D., of the Universidad de Cartagena in Colombia, and colleagues examined the association between common risk factors and outcomes, such as maternal mortality, among patients who underwent mechanical ventilation during pregnancy.

“This retrospective cohort reviewed more than 2,116 consecutive obstetric admissions, including 299 obstetric patients who required mechanical ventilation for more than 24 hours,” Rojas-Suarez said.

In patients requiring mechanical ventilation, the investigators found that obstetric hemorrhage, hypertensive disorders of pregnancy, and maternal sepsis were the most common indications for admission to the ICU. Factors associated with a higher risk for mortality included the use of a vasopressor, blood transfusions, evidence of neurological dysfunction or coagulopathy, or a diagnosis of adult respiratory distress syndrome.

“Risk factors associated with a higher mortality in obstetric patients requiring mechanical ventilation are similar to those identified in the non-obstetric population. Women with adult respiratory distress syndrome or those who developed a coagulopathy or had evidence of neurological dysfunction had an elevated risk of mortality; transfusions and use of vasopressors were also associated with worse outcomes,” Rojas-Suarez said. “Clinicians should be aware that the usual risk factors for mortality in the general population apply during pregnancy and should consider a patient with these risk factors at high risk for mortality.”

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