Hot in Journal CHEST: November 2021
By: Alice Gallo de Moraes, MD
November 4, 2021
Each month, we ask our Social Media Co-Editors of CHEST to weigh in on the hot topics in CHEST. This month, Dr. Gallo de Moraes shares her highlights of the November 2021 issue. After reviewing the issue, be sure to share your hot list on Twitter with the hashtag #journalCHEST.
It is a beautiful fall day in Rochester, MN, as I write this blog entry. Being one of the Social Media Editors for the journal CHEST® is extremely rewarding and exciting to me. It is always an honor to highlight the work of my colleagues.
CHEST 2021 just wrapped up, and it was so good to see all of you, even if it was behind a screen.
Now, let’s talk about some great manuscripts coming out in journal CHEST’s November issue.
Parapneumonic Effusions Are Characterized by Elevated Levels of Neutrophil Extracellular Traps
The formation of neutrophil extracellular traps (NETs) is part of the way neutrophils can entrap and kill microbes. NETs have been implicated in acute and chronic diseases, including asthma, COPD, and cystic fibrosis. The presence of NETs in fluids and tissues is beneficial in some circumstances but harmful in others. Twaddell SH et al looked into the concentration of NETs in parapneumonic effusions compared with other types of effusions as a potential reflection of the inflammatory quality of parapneumonic pleural effusions. The authors found high levels of NETs in parapneumonic effusions. NETs may be significant contributors to the viscosity of those effusions and may also help understand the potential therapeutic benefit of deoxyribonuclease in the treatment of empyema.
Achieving Safe Liberation During Weaning From VV-ECMO in Patients With Severe ARDS: The Role of Tidal Volume and Inspiratory Effort
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is highly utilized in patients with severe ARDS worldwide, despite the lack of definitive evidence supporting its use and high patient mortality. Weaning from VV-ECMO is not well studied, and the predictors of safe liberation are still unknown. Al-Fares AA et al analyzed mechanical ventilation settings, respiratory mechanics, and clinical variables to predict successful liberation from VV-ECMO. The authors found that higher tidal volume per predicted body weight and heart rate were significantly associated with odds of unsafe liberations, adjusted for age and SOFA scores. Patients with higher inspiratory efforts during a sweep gas-off trial also had unsafe liberation from VV-ECMO and overall worse outcomes.
Safety of Thoracentesis and Tube Thoracostomy in Patients With Uncorrected Coagulopathy: A Systematic Review and Meta-analysis
Thoracentesis and tube thoracostomies are commonly performed procedures. And as any invasive procedure, they also carry complications, bleeding being one of the potential ones. Guidelines addressing periprocedural management of bleeding risk have restrictive recommendations, including but not limited to correcting international normalized ratio to above 1.5 and stopping warfarin many days before the procedure, for example. Fong C et al systematically reviewed the available literature on the safety of thoracentesis and tube thoracostomy in patients with coagulopathies. The authors found that major bleeding and mortality complications were uncommon among patients who underwent those procedures with uncorrected coagulopathy.