The final of four Clinical Year in Review sessions at ATS 2022 was held on Wednesday, May 18, and featured reviews of some of the most important and impactful papers published over the past year in long COVID and post-intensive care syndrome (PICS), acute respiratory distress syndrome (ARDS), interventional pulmonology, and medical education.
Kimberley J. Haines, PhD, BHS, of the University of Melbourne in Australia, began the session with a review of recently published papers looking at outcomes of long COVID and PICS.
“It is important to acknowledge that survivors of COVID-19 can go on to develop an array of cognitive, physical, and mental health symptoms and impairments,” Dr. Haines said. “As the pandemic stretches ahead, it is becoming increasingly recognized that there is a growing cohort of survivors with long COVID who are experiencing distressing symptoms and the magnitude of the ongoing mental and physical health burden is substantial.”
Among the studies she reviewed was a study from Australia looking at the short-term physical, mental, and cognitive outcomes following COVID-19 critical illness. Importantly, she said this study included a comparison between survivors of COVID-19 and non-COVID-19 acute respiratory failure to better understand the impacts of COVID-19 on post ICU disability.
“The patients with COVID-19 were older, had lower APACHE 2 scores, and a longer duration of mechanical ventilation. Despite this, at six months there was no difference in incidence of death or new disability between patients with COVID-19 compared to non-COVID acute respiratory failure,” Dr. Haines said. “This study highlights the importance of screening for new post-ICU impairments for all ICU survivors, as survivors in this study reported new disability irrespective of diagnosis for COVID-19.”
Kusum Sara Mathews, MD, MPH, MSCR, Icahn School of Medicine at Mount Sinai, followed with a review of clinically relevant studies in ARDS published over the past year, including findings from a post-hoc analysis of the EPVent-2 trial looking at the effect of esophageal pressure-guided positive end expiratory pressure on ARDS survival.
The study findings, she said, suggest that patients with low severity of illness appear to benefit from PEEP titration guided by esophageal pressure (Pes), and that an end-expiratory transpulmonary pressure target of 0 cm H2O is associated with better outcomes.
“The results also support that Pes-guided therapy to a transpulmonary pressure of 0-6 cm H20 in those with shock may have worsened hemodynamics and thereby worsened outcomes,” Dr. Mathews said. “Other targets may be safer for this particular subgroup and warrant further investigation.”
Joseph C. Cicenia, MD, Cleveland Clinic, followed with an update on recent findings in interventional pulmonology, including the results from a study looking at factors associated with diagnostic accuracy of robotic bronchoscopy.
The investigators reviewed consecutive cases of robotic bronchoscopy done at their institution over an 18-month period. Data was reviewed retrospectively, and all patients had at least 12 months of follow-up.
“Overall diagnostic accuracy was 77 percent, in line with other studies using robotic bronchoscopy,” Dr. Cicenia said. “Localization, as defined by system imaging was 94 percent, however if defined by radial EBUS (rEBUS) imaging it was 82 percent.”
Additionally, he said that neither presence of a bronchus sign, nor the type of rEBUS view, were associated with higher yield, which may set robotic bronchoscopy apart from prior navigational platforms.
In the final presentation of the session, Stacey M. Kassutto, MD, of the Perelman School of Medicine at the University of Pennsylvania, reviewed recent developments in medical education, including findings from a study looking at diversity in medical education and the ways that lack of diversity has affected inequalities in medical education.
The study, she said, examined data on gender, race and ethnicity of U.S. medical school enrollees from 1978-2019 using data sets provided by the Association of American Medical Colleges.
Among the findings, Dr. Kassutto said there were only modest increases in the percentages of Black women and an actual decrease in the percentage of Black men. Overall, she said that, compared to relative percentages in the U.S. Census, the medical school student body remains under-representative of men and women who identify as Black, Hispanic, American Indian/Alaskan Native, and Native Hawaiian/Other Pacific Islander, as well as white women.
“The lack of significant improvement in the racial and ethnic diversity of the medical student body in the last four decades underscores the importance of a renewed focus on medical school admissions processes to promote recruitment of applicants from historically excluded groups by adopting holistic application review processes, addressing structural issues such as standardized testing, prerequisites, and advising, and investing in pipeline efforts,” Dr. Kassutto said.
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