Saline for Resuscitation, Cancer Screening at CHEST 2017

TORONTO — Whether or not to use saline to resuscitate critically ill patients, a new bronchoscopy peripheral navigation system to assess lung nodules, and updated guidelines for lung cancer screening will be evaluated at the upcoming CHEST 2017: American College of Chest Physicians Annual Meeting.

The use of saline to resuscitate critically ill adults "has been a big clinical controversy" because of its high chlorine content, which can lead to acute kidney injury, said Peter Mazzone, MD, from the Cleveland Clinic, who is scientific chair of the meeting.

Results from two large trials comparing the use of saline with balanced crystalloids will be presented and will likely be hotly debated, he told Medscape Medical News.

A new technology for visualizing lung nodules, used in combination with ultrasound, will be presented by Douglas Hogarth, MD, from the University of Chicago.

And a trial of patients with chronic obstructive pulmonary disease will compare the effectiveness of two drug combinations. "The results will show important advances," Dr Mazzone reported. And "we expect new treatments for pulmonary hypertension to garner attention."

Updated Guidelines

Dr Mazzone said he is looking forward to the sessions in which experts from the Fleischner Society discuss revised guidelines on incidental pulmonary nodules, look at distinct morphologic types, and explore techniques to more accurately measure them.

And during a plenary presentation, he will review updates to lung cancer screening guidelines, which are exceedingly important because of the technologic advances that have occurred over the past few years.

"This is always a hot topic of discussion among our members," said CHEST President Gerard Silvestri, MD, from the Medical University of South Carolina in Charleston.

Since 2013, when the guidelines were last updated, a lot of screening and smoking-cessation programs have been implemented.

In fact, new directions from the Centers for Medicaid and Medicare have led to shared decision-making with the patient and the incorporation of smoking cessation into the lung cancer screening visit. "Both are really important," Dr Silvestri pointed out, "and the way we go about screening different groups — the elderly, younger smokers, older smokers — is important to discuss."

The theme of this year's conference — Team-Focused: Patient-Centered — is threaded throughout the meeting, from the selection of opening-session speakers, to the development of educational content and research presentations, to networking and foundation functions.

Physician Assistants, Respiratory Therapists, and Nurses

The aim is to better support the interprofessional gathering of respiratory therapists, registered nurses, nurse practitioners, physician assistants, and physicians.

A lot of care in this specialty is delivered by a team, and many team members have no way to get the intensive training opportunity offered at this meeting, Dr Silvestri pointed out.

To ensure that sessions meet the needs of all members of the pulmonary healthcare team, advance practice providers were included on the program committee.

"We've done a lot to attract nurse practitioners, for example," he explained. Advance clinicians at the planning table made it clear that they want to attend the same sessions as physicians and "want information at a level that challenges them."

Interdisciplinary teamwork will be a focus of the talk delivered by inspirational speaker Ross Bernstein, entitled The Champion's Code: Building Relationships Through Life Lessons of Integrity and Accountability From the Sports World to the Business World.

Simulations and Gaming

Hands-on simulation sessions — "one of the distinguishing features of the CHEST meeting" — let providers learn in a risk-free environment, Dr Silvestri said. "We're at the forefront of techniques to help people improve their skills in procedural simulation."

Daily games will allow participants to go through patient scenarios in a fun way. The arcade-style Phingo game provides clues related to the treatment of pulmonary hypertension, and players mark bingo squares when a treatment matches the clue.

In another game — Pulmonary Adventures II: Temple of Gloom — players read a patient history, look at 10 chest radiographs, CT scans, or both, and then have to select the best step for diagnosis or management to avoid being corrected by the evil Dr Contrarian.

In the Aspirated! game, players use a flexible bronchoscope to find and remove a standardized foreign body dropped into a low-fidelity simulator, and the fastest time wins.

"We get a lot of good feedback on the gaming portion of the conference," Dr Silvestri said. "It's a lot of fun."

Dr Mazzone and Dr Silvestri have disclosed no relevant financial relationships.

Follow Medscape on Twitter @Medscape and Ingrid Hein @ingridhein

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