Pulmonology
Physician discussions on respiratory conditions, critical care, interstitial lung disease, and pulmonary procedures.
Recent Discussions
Does your approach to extubating obese patients differ from your approach in non-obese patients?
If the patient has OSA/OHs I often extubate directly to CPAP OR bipap especially if they have high compliance to OSA cpap therapy and are "used to the mask". But if high levels of secretions, NIV can make clearance of secretions more difficult. Thus, individualize therapy is indicated.
When do you entertain a diagnosis of HLA-negative antibody mediated rejection in lung transplant recipients?
What therapies do you routinely use to prevent mucus plug formation after endobronchial stent placement?
After airway stent placement, especially silicone stents and/or Y stents, I start my patients on albuterol neb BID; hypertonic saline neb BID, and NAC neb BID. If there are any issues with adherence, I use either albuterol + hypertonic saline or albuterol + NAC depending on patient preference. If th...
Did the low rate of COPD exacerbations in the BOREAS cohort overall confound the results of the study?
I feel that the results are still very impressive despite this.
Are the results of the BOREAS trial generalizable to non-white populations?
There is currently not enough data to conclude that the trial is generalizable to non-white population.
Will you use FeNO testing in all COPD patients to determine whether they are candidates for therapy with dupilumab?
I suspect high eosinophils will be used more often.
How long do you normally wait before considering any bronchoscopic procedure (EBUS-TBNA, Transbronchial biopsy) after an episode of acute PE in a patient needing these procedures?
This depends upon the indication for bronchoscopy and the risk stratification for an acute PE. Generally, anticoagulation can be stopped safely for a short period of time after 10 to 14 days of therapeutic coagulation in low-risk PE but for higher-risk patients or if the bronchoscopy is not urgent a...
What are your top takeaways from CHEST 2023?
There were so many great presentations: My top 3 were the following. Pulmonary Hypertension: Expert Didactics and DiscussionThe Pulmonary Hypertension: Expert Didactics and Discussion course was a half-day discussion on pulmonary hypertension evaluation and management. This was a master class that ...
How do you manage immunosuppressive medications in patients who develop a pneumonia?
For most bacterial pneumonia in transplant patients, I prefer to avoid changing immunosuppressives and simply administer appropriate antibiotic therapy. This approach is effective and minimizes the risk of triggering acute rejection. For viral etiologies, I will often reduce or hold cell cycle inhi...
Do you add fludrocortisone to hydrocortisone when starting stress dose steroids in a patient with septic shock?
In septic shock, vasoplegia is mostly believed to be related to widespread inflammation that giving hydrocortisone is supposed to address, and current guideline suggests hydrocortisone only is sufficient. However, it makes sense to add fludrocortisone since most of these patients present with undefi...