2023 CHEST Conference Highlights

Podcast Transcript

Raed Dweik, MD:

Hello, and welcome to the Respiratory Exchange Podcast. I'm Raed Dweik, chairman of the Respiratory Institute of Cleveland Clinic. This podcast series of short, digestible episodes is intended for healthcare providers and covers topics related to respiratory health and disease.

My colleagues and I will be interviewing experts about timely and timeless topics in the area of pulmonary, critical care, sleep, infectious disease, and related disciplines. We will share information that will help you take better care of your patients today, as well as the patients of tomorrow. I hope you enjoy today's episode.

Aanchal Kapoor, MD:

This is Aanchal Kapoor. I am one of the staff in Respiratory Institute. I am here with my colleagues Angel Coz and Colin Gillespie. We all three were in CHEST 2023 this year, and here we are to discuss our highlights and, and share our experiences with CHEST conference, and, in a while, I'll let Dr. Coz introduce himself.

Angel Coz, MD:

Hello everyone, my name is Angel Coz. I am pulmonary and critical care staff, here at the Respiratory Institute, and I also hold key leadership positions with CHEST. I am a member of the board of regions, and I also am an outgoing member of the guidelines oversight committee.

Aanchal Kapoor, MD:

Dr. Gillespie?

Colin Gillespie, MD:

I am Colin Gillespie. I am member of interventional pulmonary group, here at the clinic, and have been a member of the educational committee at CHEST, and an actual participant in the simulation programs.

Aanchal Kapoor, MD:

Thank you both, as we all experienced that there was a big presence of Cleveland Clinic within the CHEST meeting. We had around 75-80 sessions, including panel discussions, podium presentations, poster presentations by our multi-disciplinary team, including physicians, nurse practitioners, physician assistant, resident, and fellows over there and we had a great time together. There was participation by multiple committees in multiple sessions, and clearly Cleveland Clinic was one of the highlights of all the sessions.

Dr. Gillespie, we can start with you, what sessions you went to, and what is your experience with the CHEST?

Colin Gillespie, MD:

My biggest time commitment at CHEST this year was predominantly working at simulation sessions for CHEST. You know, I think that the simulation program that CHEST offers practicing pulmonologists is unique and a big draw for many people who are in practice, so I personally did sessions on chest tube insertions, tracheostomy, and retrieval of foreign bodies from the airway, as well as recognition of EBUS imaging. So, you know, those are very well attend sessions, generally, relatively small groups, with no more than three to one ratios from learner to faculty, and it's a great opportunity to, sort of, keep a sense as to what are the challenges for people in practice in maintaining a high level of proficiency in procedures they might not get to do as frequently as we do.

Aanchal Kapoor, MD:

Thank you. Any feedback you want to share from those sessions, from the participants?

Colin Gillespie, MD:

The interest in doing our own procedures remains strong within the pulmonary and critical care community, and, you know, that's a challenge as the technical demands of procedures go up. You know, I think that we still haven't totally figured out how best to adjudicate our abilities, and so, I think that, you know, simulation is vital for people in practice, to sort of get a sense for how do they do something, and then, hopefully, you know, inspiring, you know, not just ourselves, but the community, to set very high standards of quality, to make sure that we're going back and looking at our outcomes and doing the best work we can.

Aanchal Kapoor, MD:

Thank you. Dr. Coz, which sessions did you attend and how was your experience with the critical care section, mainly.

Angel Coz, MD:

Yeah, this year was very, very innovative when it came to the critical care part, and I particularly enjoyed it very much and what I enjoyed the most was the representation from our group. I saw that there were several sessions that had several faculties from our institute, and I was very nice to see. One session that I liked, particularly, was the critical care network highlight, which was a session on vasopressors, and it had Seth Bower, which is one of our pharmacists here in the ICU, but it had a panel from all over the world that was Marlies Ostermann, who was the previous vice chair of surviving sepsis guidelines, and then was also a president of the India Society of Critical Care Medicine. That session was really well attended and it was really well delivered, and, I think it gave us with some important lessons to our practice in critical care, and there were also another session in which two of our pharmacists were faculty, talking about the differences in the use of base oppressors and providing a pragmatic approach to the day to day clinician, so they can take the bad side and use those lessons in the care of their patients.

I, personally, participated in a few sessions. I, for the second year, gave the critical care year-end review which is a one-hour session. There's two of them, one of them focuses on trauma, neuro and mechanical ventilation, and the other one focuses on ARDS, sepsis and surgical critical care. My part was related to sepsis, and this is a session that I particularly enjoyed doing because it one, reinforces me to refresh all the reading because I have to prepare this lecture, and it takes a lot of hours of preparation. It's several articles I have to comb through.

I actually have a shared folder with one of my friends who used to do this session in the past, and we keep this folder in Dropbox, in which we put all the articles pertinent in sepsis throughout the year, and then, at the end of the year, when it's time to, close to the meeting, I have to go through all the articles and decide what is going to be good to put in that, because it's a 20-minute session, but, kind of try to summarize the articles from the whole year as it's a lot of work, but it's actually very rewarding and allows me to stay current, and there were also,-a few sessions in guidelines that I did that I think were also very well received, and were also very interactive, and I think this is also important to highlight because we have several members of our institute who are participating as panelists in some of these guidelines in critical care. We have one of them, which is in transfusion of blood products in critically ill patients, which is close to being drafted, the final recommendations. Then, we have another one which is on renal replacement therapy in critically ill patients, in which Matt Siuba, one of our critical care faculty, is a member of the panel. That one where it’s in the draft of recommendations, so we should expect to have a manuscript, hopefully, in the next six months. And then, there's a new proposal that was accepted, not long ago, on the management of septic shock, in which another member of our group is also a panelist. So, there's strong and growing participation from members of our group in this guideline domain, I think that's also very important to highlight.

Aanchal Kapoor, MD:

Thank you, Dr. Coz. As we all can witness this, this meeting was a good balance of education, research, quality improvement, as well as wellness opportunities. I, myself, in addition to all these sessions, happened to attend one of the wellness sessions, which was really well done. It was going from Tai Chi to what type of food habits you should develop, what type of behavioral changes you should be making, and every single time I crossed that section, it was full. Any experience with the exhibit hall, or, or the escape rooms? Any one of you have?

Angel Coz, MD:

I have not done the escape room, personally, myself. I'm afraid that I'm not gonna be able to come out, but I know that some of my colleagues have friends from other institutions who have done it, and they experience, they think it's a lot of fun. The experience, the exhibit hall, actually, was also a very nice experience because several of our fellows have presented in the sessions that are called "Experience CHEST". Those are bite size learning pieces that is a ten minute talk on very, just, take home points and last year they did several of them, and this year also, I know that they did some of those, and also the exhibit hall is where the posters, and the rapid fire sessions occur, and we had several residents, and fellows and APPs as well, present in this area.

The exhibit hall, this year, because of the footprint of the conference center in Hawaii was a little bit smaller, but I think, despite that, there was great attendance, and also the meeting was, to my knowledge, the one that had the largest audience in history for CHEST, so it's been a big, big hit, despite being in Hawaii, because sometimes there's constraints with budgets and the ability to take time away from work to go, yeah, several thousand miles away, but despite that, it has been a very well attended meeting.

Colin Gillespie, MD:

And there was a lot of buzz that I heard, that, just, you know, with being the largest attended CHEST, that almost 40 percent of those attendees were trainees, so that there's a lot of the youth movement is strong with people's interest in the ACCP in CHEST is a good meeting to attend.

Angel Coz, MD:

Yeah, that's correct. There were actually a large number of trainees in the session. I don't know exactly the number, but I know that there was a big presence, and that was reflected in the number of posters and case reports that were presented by trainees and I think this just speaks to a few things. One, is that there's interest in our profession, in our field, but also that trainees are finding that, or the youth is finding that the way that CHEST does teaching is appealing because, I mean, they do it in a way that is fun, so, and I mean, young people especially enjoy that, so.

Aanchal Kapoor, MD:

And I think post COVID, also, right? This is one of the biggest meetings in a good locality, and people were eager to come and meet, and I really like how CHEST embedded networking sessions within the meeting. I just recently joined a network, and there were multiple opportunities to meet with those people at different hours so that I can meet them during the day, as well as, if needed to, in the evening times.

Angel Coz, MD:

Yeah, and I think that is one of the important parts of having these meetings in person. Because it allows to network, because I think the network is one of the most important things of this meetings because it allows you to connect to the people, see how they do things, see what you can learn from them, seek what they can learn from you, and, ultimately, more opportunities to be in different projects and education, research, guidelines, et cetera, so the network is really important. I think that's something that we have grown over the last couple of years with our growing presence in CHEST.

Aanchal Kapoor, MD:

Mm-hmm, surely, that those people you meet, you can think of next proposals what you are going to propose for 2024.

Angel Coz, MD:

Exactly, and you meet them in a more relaxed environment, usually, I mean, with me, not work-related stuff, I mean, maybe a few drinks, here or there, so it's a lot more relaxing and, I mean, a lot more things can happen organically.

Aanchal Kapoor, MD:

From education content, I personally found that it was a portfolio of critically ill, critical illness. For example, I went to mechanical ventilation sessions, fluid pressers, sepsis, pro/cons of artificial intelligence, controversies in mechanical ventilation, so it felt like, you know, I am there and learning every single aspect of critical care. Any experience with pulmonary sessions?

Angel Coz, MD:

I, personally, only attended maybe a couple of pulmonary sessions. They were on pulmonary physiology, cardiopulmonary exercise tests and they were really, really interactive, and they're really fun, but most of my focus was critical care. I don't know, Colin, if you?

Colin Gillespie, MD:

I attended a session that was started by one of our fellows. Graham Stockdale presented a case, a bunch of people talked about the ICU management of people with obstructive lung disease, and our own Eduardo Mireles spoke about rescue strategies for people who are really, particularly challenging to ventilate, that I thought was really nicely done.

Aanchal Kapoor, MD:

First time I was part of non-pulmonary critical care session, where my talk was on acute liver failure, but it was heavily weighted on obs, obs critical care, and many of our applicants who come in, they do ask that experience, so I was very happy to see obstetrics as a part of critical care in that session, including endocrine, I think the fourth topic was neuro critical care, so well-rounded experience in CHEST this year.

Angel Coz, MD:

Critical care is the part of the program that has the largest footprint. Typically, on average it's around 30, 25-30 percent of the meetings is critical care, so whoever has to put that part of the meeting together is, carries a lot of the weight on their shoulders, but, ultimately it's where, to get a great experience, but it's, I don't know how many sessions were this year, but when I did it a few years ago, I think they were around 55-60 critical care sessions, and then, the rest was divided among pulmonary and sleep medicine, but there's a big, big critical care presence.

Aanchal Kapoor, MD:

Both of you, Colin and Coz, do you have any recommendations for our future applicants to test when they're writing their proposals, I mean, you have been a big part of CHEST for years and years, do you have any suggestions for them?

Angel Coz, MD:

Yeah, so, I think the things that are most important when you're thinking of a submission is, one, to have a topic laid out in a way that is didactical, so that, actually, you can see how the audience would appreciate that session, and then, when it is developed, a few things that are very important for the program committee, from my experience in the past are that there is diversity in all aspects and CHEST no longer accepts panels in which they're all males, or, and there's also geographic diversity, so a lot of time when we put sessions together, we're tempted to maybe put people we know, and those people tend to be from the same institution. That is something that may actually decrease the chances of your proposal being accepted, so if, I mean, you're interested in doing that, may not know other people who could potentially participate in the panel, you can reach out to the leadership, they are very open, very welcoming to help and, kind of, work with you to put a proposal together, and, maybe find, identify a speaker with similar interests from other parts of the country, so that way, your session has much higher chances of being accepted.

Aanchal Kapoor, MD:

Thank you. Colin, do you want to highlight how to submit for simulation?

Colin Gillespie, MD:

Um, why, I think that, you know, one of the key pieces of advice for a young person looking to put a package together, or a session together, is, you know, what are the problems that you struggle with in your daily life? You know, CHEST, I think, is a very practical organization, and if you find something interesting or challenging, that's a great place to start because you can guarantee that what your wrestling with is something that someone else is wrestling with, and so, the more you can sort of put a session together to address a problem or a need that you went to literature to go look up, or to find the answers to, that's a great place to start.

You know, when you're putting together a simulation session, you know, what are the skills that you're working to acquire? Where are the things that you would wish you could get more practice, or get, you know, an expert to sort of help walk you through a problem? You know, those are the ways to go, to move forward, and that's often, you know, combining new technologies, so the emergence of thoracic ultrasound in procedural medicine for taps, chest tubes, identification of pneumothorax. That's a skill that you can practice and that you can learn pattern recognition, but it's hard to do on your own. So, you know, really trying to put together something that you think you're going to bring a nugget of experience in a digestible way, is the place to start.

Aanchal Kapoor, MD:

Thank you.

Angel Coz, MD:

One of the types of submissions I think are really popular are the ones that are case based. Just, kind of, building on what Colin mentioned that finding those areas in which you struggle or you find that there's maybe not clear guidance, you can build a case from that, and sometimes those lend to different topics to be dissected or to be explored further, or sometimes create pro/con debates, and those are usually fun because, at the end of the day, nobody necessarily has, I mean, nobody is right, neither side, but it actually helps the audience a lot to see that, two different points of view, and where sometimes there is a lot of common ground and sometimes in areas in which there is a discrepancy, and that helps the day to day clinician, kind of see where we all struggle and, kind of, see that our problems are not, are not unique, and kind of take that information and be able to apply that back home. And other sessions that are also really, really helpful, but for this, there is probably a little bit of a need for more interaction with the education department or the education community is the practice-based learning sessions.

Actually, I did one of these that I enjoyed very much, I did not know how it was going to turn out, but I think my audience enjoyed it a lot, it was they who gave me this title is, "Managing the Critically Ill Patient, using Guideline Based Medicine." It was, basically, what I did was created a case in which there were several decision points that needed to be, decisions needed to be made and then use the evidence tables from the guidelines to actually have my attendees kind of come to their own conclusion, and kind of, mimicking what a guideline panel does when they sit at the table and kind of decide what recommendation is going to be made, so they actually understand, understood what the source of making a guideline is, and they actually found it very, very interesting, and I think those are also things that could be useful with a little bit more of an education, background education, that can be put together.

And CHEST is very open to helping interested people to do this. They are very open to helping put sessions together, because, at the end of the day it's the talent, when they, when we put our heads together, we create better content.

Aanchal Kapoor, MD:

Thank you, Coz, for all the recommendations and suggestions for people. I, also, ended up attending a post-course session. My plan was to do a pre-course but, by the time I applied, the seats were full. There were multiple leadership sessions as a pre-course, and the post-course session I actually attended was critical care. It was again the potpourri of things, but the beauty of it was sort of one on one. There was not too many people and the faculty, most of the faculty I knew from before, so it was really good mix of faculty plus multiple topics, including sepsis, fluid, ARDS, CRRT, so all the sessions where they were hour long sessions in the course, now it has one-on-one case-based discussions on all those sessions. As you pointed out, it was all like, this is the case, how evidence is being applied at multiple steps within the case. I really loved that post-course on critical care.

In addition, I, personally, liked how they started the sessions and how they finished the sessions. It was an early start and early finish, and you see people on the streets, in the restaurants, and the people who wanted to enjoy Hawaii were given the time by CHEST to enjoy the time over there.

Angel Coz, MD:

Yeah, that's done by my side of me taking advantage of the time difference, so if you from the west coast, have a three-hour advantage, so they're ahead, so, I mean, you can actually start very early. My early session, I was at 5:15 in the morning.

Aanchal Kapoor, MD:

Yep.

Angel Coz, MD:

I was, I don't know why I did that, because it was on almost the last day, so I was already kind of adapted to the Hawaiian time zone.

So, I regret very, very, very fondly doing that session at 5:15, but I can see how because of the time change, people can start early, but the purpose of that is to finish by 2:30, 3 PM, so you have the whole afternoon to do as you please around the island, and, I mean, it's a beautiful place to visit, and you can have a little fun there.

Aanchal Kapoor, MD:

True.

Colin Gillespie, MD:

I think, just to remind people that you hinted on this, that, when you're going to these meetings, if you're interested in joining a particular session, if it's a ticketed session, you really want to sign up early, you know, so when the agendas are put out, really spend a few minutes to look through what's coming, and put your name out there, because otherwise these sessions do fill, and they can fill quite quickly, so the earlier you, you know, make your plans to what you want to accomplish, the more like you are to do it.

Angel Coz, MD:

Yeah, that is true because those sessions sell out really quickly, and then, sometimes they may add an additional one, but there's so many sessions that faculty can do, so if you're interested in this ticketed sessions, which are usually very, very high quality, very small groups, so they're really, really nice to attend, so, but you need to sign up early.

Aanchal Kapoor, MD:

Thank you both. Any other thing which we haven't highlighted, you want to point out?

Colin Gillespie, MD:

Well, I would like to give a shout out to our Dr. Atul Mehta, who was part of a really rousing and stimulating pro/con debate on flexible versus rigid bronchoscopy, and, you know, pro/con debates, I do think are, you know, not just entertaining, because they're usually engaging speakers, but it's good to recognize that there's more than one way to skin a cat. I think, very often, you know, when, if you're a fellow and in the ICU, your attendings can make things feel like there is a right way to do this, but from one week to the next, those right ways could be very different from each other, and so it's a really good way to keep an open mind, and to recognize that there, there's multiple different ways to approach a problem.

Angel Coz, MD:

Yeah, I agree, and I think that pro/con debates highlight that to the maximum, and I think it allows us, in the audience to see that there's multiple ways to get from point A to point B, and, to me, none of them is necessarily the best, it depends on your skill set, and sometimes even the patient that you have in front of you, so, and that's really important. One thing that I wanted to highlight is that the deadline for the submissions is November 30, so, if you're interested in submitting a session, or a proposal, you have until November 30 to submit your proposal. Again, keep it in mind that it needs to be diverse, that topic needs to be engaging and sometimes we tend to think that, if we go deep into a very specific topic, that's going to make it more appealing. That's not necessarily the case. You want to keep the experience to a clinically applicable level, so you want to make sure that you cover the bases of critical care and pulmonary medicine, maybe going a little bit deep in some topics, but not going really, really deep, because that is not what we trying to present when we're doing the annual meeting.

And two is, the diversity of disciplines. You want to have physicians, pharmacists, trainees, also APPs, in the panel, and also geographic diversity and of course, gender diversity. There is no single session, and we have been keeping track of that for some time now. There are not anymore, those manuals that sometimes still exist in some presentations.

Aanchal Kapoor, MD:

Thank you, Dr. Coz, for your advice. For the time, we will finish our discussion here. Thank you, Dr. Colin Gillespie and Dr. Angel Coz. Feel free to contact Dr. Coz for further submissions. He is a really great mentor for the next submissions. Thank you, all.

Raed Dweik MD:

Thank you for listening to this episode of Respiratory Exchange podcast. For more stories and information from the Cleveland Clinic Hospital Institute, you can follow me on Twitter, at RaedDweikMD.