Scleroderma, Sleep Apnea, Sepsis Highlights of CHEST 2015

Kate Johnson

October 16, 2015

MONTREAL — Late-breaking results from the Scleroderma Lung Study II will be among the top findings reported at CHEST 2015: American College of Chest Physicians Meeting.

The trial builds on the first Scleroderma Lung Study, previously reported by Medscape Medical News, which "established cyclophosphamide as one of the cornerstones of care for scleroderma patients," said Alexander Niven, MD, from the Madigan Army Medical Center in Tacoma, Washington, who is cochair of the scientific program committee.

The lack of sustained improvement with cyclophosphamide led researchers to their latest investigation — a prospective randomized placebo-controlled trial comparing mycophenolate mofetil with cyclophosphamide. "It will be a very important session," Dr Niven predicted.

Respiratory specialists and cardiologists still digesting the practice-changing SERVE-HF trial will be interested in the session on the impact of the trial results on the management of central sleep apnea in heart failure patients, he added. A panel discussion will explore the clinical implications of the trial's surprise finding that adaptive servo ventilation increased mortality in heart failure patients with reduced ejection fraction, signaling "a really a dramatic departure from the conventional thinking in this area," Dr Niven reported.

The wide array of session formats aimed at providing a full range of learning opportunities is a unique strength of the CHEST meeting, said Jean Bourbeau, MD, from the Montreal Chest Institute, who is cochair of the scientific program committee. "We have a lot of different methods of education that allow clinicians to understand new practices, but also to practice," he told Medscape Medical News.

Hands-on Simulation Experience

CHEST has been building on a centerpiece of this concept — the simulation center — since 2007, Dr Niven reported.

In one of these sessions, "we will reconstruct a clinical ICU room with a high-fidelity human simulator on a real hospital bed. The simulation community would recoil if we called it a 'dummy'!" he said. There will be a cart with all the equipment for airway management, a mechanical ventilation area, and a real ventilator connected with tubing to the 'patient'. We will have the opportunity to adjust some of the parameters to simulate things like pneumothorax" so our learners can troubleshoot, Dr Niven explained.

This year there will be an opportunity to perform a cricothyroidotomy, "which is a rarely performed, but very important emergency skill that all intensivists who manage airways should have practical experience in," said Dr Niven.

Some hands-on opportunities, such as pulmonary function testing and ultrasound procedures, will involve live "standardized patients."

"Usually, you have to go to an institution to get that kind of practice," Dr Bourbeau explained, but this is offered onsite. "Probably the worst way to learn is just to have someone telling you. We have tried to incorporate many other methods, such as workshops, problem-based learning opportunities to put new guidelines into practice, and educational games. All are quite different but allow the healthcare professional to become an active learner."

New Era of Medicine

Organizers are offering interdisciplinary programs, which are designed to encourage a multidisciplinary and multiprofessional focus on care and to attract a mix of doctors, nurses, and respiratory therapists by simulating real-world settings.

"We are entering a new era of practicing medicine — whether in the intensive care unit or sleep medicine clinic or in chronic care medicine — which will require more and more of a multidisciplinary and multiprofessional team," said Dr Bourbeau.

Organizers have saved a potentially controversial session on sepsis management as an adrenaline bolus at the end of the meeting. On the heels of three recent studies that have challenged the early goal-directed therapy approach to sepsis (PROCESS, ARISE, and PROMISE), speakers will address the Surviving Sepsis Campaign and discuss the impact that new evidence will have on current clinical practice.

Dr Nevin and Dr Bourbeau have disclosed no relevant financial relationships.


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