American College of Chest Physicians, Oct. 25-30
The annual meeting of the American College of Chest Physicians was held from Oct. 25 to 30 in Austin, Texas, and attracted approximately 6,000 participants from around the world. The conference featured presentations focusing on clinical updates in cardiopulmonary medicine, including advances in critical care and sleep medicine.
In one study, Peter J. Mazzone, M.D., of the Cleveland Clinic, and colleagues found that there are many metabolites in an individual's blood stream the levels of which are different in those with lung cancer.
"By understanding these metabolite differences we may learn more about how cancer develops, find different treatment targets, and be able to develop tests to help identify and characterize the cancer," Mazzone said. "This study was a discovery-level study. The next step would be to validate the results and determine if easy-to-use assays could be developed that would impact clinical care."
In another study, Jared Radbel, M.D., of the Staten Island University Hospital in New York, and colleagues sought to identify recent mortality trends for acute respiratory distress syndrome (ARDS). From the largest all-payer inpatient health care database in the United States, the National Inpatient Sample database, the researchers identified 174,180 patients with ARDS from 1996 to 2011 using International Classification of Diseases, Ninth Edition, coding. When the investigators expanded their search to estimate country-wide discharges, the overall data represented 856,293 patients.
The investigators observed a decrease in the ARDS case fatality rate, from 46.8 percent in 1996 to 32.2 percent in 2011. This corresponds to an absolute mortality reduction of 14.6 percent and relative reduction of 31 percent. The investigators also found a sharper decline in mortality from 2000 to 2005. Over this time frame, the investigators found an absolute reduction in case fatality rate of 8.9 percent.
"In the largest study to examine mortality trends in ARDS from 1996 to 2011, we demonstrate a clear decline in ARDS mortality. Our study helps resolve discrepancies found in previous large meta-analyses studying ARDS mortality in similar timeframes," said Radbel. "We believe that collaborative advances in critical care medicine contributed to the overall decline. However, we assert that the sudden and sharp decrease in mortality from 2000 to 2005 may be attributed to low tidal volume ventilation."
Mary Baker, M.D., of Indiana University-Purdue University Indianapolis, and colleagues studied individuals who suffer combustion injury from smoking while on home oxygen. The investigators identified two high-risk predictors for injury: substance abuse and a prior injury from smoking while on home oxygen.
"In our cohort, the mortality rate was high at 15 percent, with high associated morbidity. We had long lengths of stay, half of our patients required intubation, and many were discharged to a higher level of care," Baker said. "We need to consider carefully the patients who are prescribed home oxygen. We also need to establish protocols for use of home oxygen and find ways to screen individuals at high risk for injuring themselves while on home oxygen. This could easily be accomplished during the home oxygen evaluation by asking patients if they smoke or have a history of substance abuse. These patients need to be followed more carefully and counseled intensely before they receive the oxygen."
Baker recommends that if a patient gets burned from smoking on home oxygen, practicing clinicians need to seriously consider whether they should be sent home with oxygen again.
"We as providers need to discuss this further and come up with a consensus on how to address this because currently this conversation has not been had among those who prescribe home oxygen to patients," Baker added.
In a retrospective chart review of all the patients over the last 10 years who had tree-in-bud (TIB) appearance on chest computed tomography (CT), Vikas Pathak, M.D., of the University of North Carolina in Chapel Hill, and colleagues compared patients who had bronchoscopy for the diagnosis of TIB versus patients who had TIB appearance on chest CT who did not undergo bronchoscopy. The investigators concluded that patients with TIB appearance on the chest CT with no associated CT finding do not need bronchoscopy for further diagnosis and management. In addition, clinical suspicion/sputum culture is sufficient to make a diagnosis in most of the patients.
"I think patients with TIB on CT with no associated findings should not be subjected to bronchoscopy. Sputum culture was as good as bronchoscopy for the diagnosis. Patients could be easily followed with repeat CT if there is any concern. In future, a larger, randomized, prospective study would be more useful in helping delineate the group that would benefit from bronchoscopy," Pathak said.
CHEST: CPAP Doesn't Adversely Affect Sex Life
THURSDAY, Oct. 23, 2014 (HealthDay News) -- A patient's sex life is unlikely to suffer because of sleep apnea treatment, according to a new study scheduled to be presented at the annual meeting of the American College of Chest Physicians, held from Oct. 25 to 30 in Austin, Texas.