2025 CHEST Conference Highlights

Podcast Transcript

Raed Dweik, MD:

Hello and welcome to the Respiratory Exchange Podcast. I'm Raed Dweik, Chief of the Integrated Hospital Care Institute at Cleveland Clinic. This podcast series of short, digestible episodes is intended for healthcare providers and covers topics related to respiratory health and disease in the areas of lung health, critical illness, sleep, infectious disease, and related disciplines. We will share with you information that will help you take better care of your patients. I hope you enjoy today's episode.

Peter Mazzone, MD, MPH (00:34):

Hi everybody. Welcome to the Respiratory Exchange Podcast. In this episode, we're going to be talking about highlights from CHEST 2025. The CHEST annual meeting just ended, and I'm very fortunate to have with me two of our leaders who participated in the meeting to share some of their insights. My name is Peter Mazzone. I'm a pulmonologist here at the Cleveland Clinic where I help direct the Thoracic Oncology Program for the Pulmonary Department. I'm also editor of the journal, CHEST. Let me just have my two guests introduce themselves. Angel, would you mind introducing yourself?

Angel Coz-Yataco, MD (01:10):

Sure, Peter. Thanks for having us. I am Angel Coz. I'm a pulmonary and critical care physician here at the Cleveland Clinic, and I have a few leadership roles within CHEST. I am the outgoing editor in chief of CHEST Physician. Finally, they're letting me out after three and a half, four years of service to the publication. In addition to that, I'm the current vice chair of the Guidelines Oversight Committee, and I am a member of the Board of Regents, so I will be entering my fourth year of service in January of this year.

Peter Mazzone, MD, MPH (01:46):

That's fabulous. Those are some big, big and important roles. Matt, would you mind introducing yourself?

Matt Siuba, DO (01:52):

Sure, my name's Matt Siuba. I'm a critical care physician here at Cleveland Clinic Main Campus. I mainly work in the medical ICU and I also do pulmonary hypertension care. And then as part of the CHEST Society, I am a journal podcast moderator for the main flagship journal CHEST. And I'm also part of the sepsis and shock committee, which is part of the critical care network.

Peter Mazzone, MD, MPH (02:13):

Thanks very much, Matt. I was embarrassed Matt had to remind me he's doing podcasts for the journal I'm editor of the that was... [No Problem.] yeah. Not smooth. <laugh> Anyway, in the last couple years we've had Respiratory Exchanges on highlights of the CHEST annual meetings that have been very informative to some of our listeners. So, I'm glad that we can circle back and talk about the 2025 meeting. And Matt, maybe I'll start with you. You know, did you have a favorite session or two and why might those have really been valuable for you?

Matt Siuba, DO (02:41):

Yeah, I think this was a great conference this year. One session that I think was very informative and really practically useful that I went to was there was a session on care of the morbidly obese patient in the ICU. And actually, one of our colleagues, Eduardo Mireles, was part of that session and talked about mechanical ventilation in the morbidly obese patient.

It was a really informative session to understand some of the challenges of taking care of this population. There were also discussions on differences in drug dosing that we might need to consider the way that we deliver nutrition. And then kind of an interesting discussion of this thing called the obesity paradox and whether or not patients with obesity have better outcomes compared to patients that don't. So there's a lot of good stuff to chew on in that session. A lot of practical take-homes.

Peter Mazzone, MD, MPH (03:22):

Was there one particular takeaway that you're going to be able to put into practice upon returning here?

Matt Siuba, DO (03:27):

Yeah, I think one really important thing is to understand what drugs are, sort of, very lipophilic and might be more likely to deposit in the tissues of patients with severe obesity. Things like, you know, benzodiazepines like midazolam that we use all the time.

And really a consideration of when we should be using actual body weight versus adjusted or ideal body weight for different drugs and, and what the implications of that might be. So, it really made me, even more than normal, appreciate the role that our pharmacists play on our teams.

Peter Mazzone, MD, MPH (03:53):

Absolutely. Thanks man. Angel, same question. Any favorite sessions? What were you really interested in?

Angel Coz-Yataco, MD (04:00):

Yeah, there were a few, and one was a session that I was asked at the very last minute to moderate. Probably the least interesting part is that I was part of that one. But what made it interesting were late-breaking abstracts and it was really nice to see the amazing work that trainees, even one of them was a medical student who had just finished this interest in randomized controlled trial, which is like amazing how earlier and earlier they're doing this type of work.

One of them was on the use of a norepinephrine peri intubation to see if that would prevent hypotension around intubation. And another one was related to the use of ultrasound in the diagnosis of pulmonary response and looking at different indexes. This one was done by a resident, which was really, really impressive. The amount of work they're putting into this very early in their career.

(04:54):

And then another session that I liked a lot, I was part of that session, but that's probably my least favorite part, was a session in which we talked about the upcoming hemodynamic guidelines in sepsis management. We are working on that guideline right now. Probably it might be released in about a year, maybe. Hopefully we'll be ready for release publication for the next annual meeting. But we reviewed a lot of the, we couldn't talk about the pico question specifically, but we talk about evidence that we identified as we are developing these guidelines.

And then another session - and as you can maybe kind of get the sense that sepsis is kind of my area of interest - there was a session in which we talk about the recent advancements in sepsis. And we had this in our sepsis education day. Steve Simpson came and gave a great talk on the newer technologies and modalities that are being used or studied to identify more precisely patients with sepsis.

(05:55):

And this was kind of a shorter version of that. But the work that is being done in this is really remarkable. And hopefully in the next 10 years we will have some sort of biomarker pool. And maybe or not coupled with artificial intelligence to be able to tell with higher degree of certainty which patient is septic and which patient is not. Because I think that is where the problem is. We give suspected sepsis, mean if you have SERS, now the patient has suspected infection and you go into circular reasoning. But that is not the point. With these new interventions, hopefully, we can have a higher degree of certainty of which patient is septic and start interventions as quickly as we can.

Peter Mazzone, MD, MPH (06:36):

Are those biomarkers also being developed to help individualize treatment suggestions based on biomarker or clinical profiles or both?

Angel Coz-Yataco, MD (06:46):

Yes. Some of those actually are able to phenotype patients based on whether they have a more inflammatory profile or more a coagulopathic profile. And if you, we think the evidence that has informed critical care trials in general for the last 20 years, basically you can overlap the Kaplan Myers of every trial and you cannot tell from which trial it came from.

(07:09):

And part of that might be that we are thinking of sepsis specifically as an entity, but I think as we are learning more about it, we are understanding that there are different phenotypes. So maybe something that, for example, activated protein C that initially we saw had some promise and then another trial said, nevermind, that was not true. Maybe what we're seeing is that if we phenotype patients and we include the patients with the right characteristics in these trials, we might be able to identify which patients might benefit from this as opposed to just including the hodgepodge population of sepsis and then kind of having all negative trials,

Peter Mazzone, MD, MPH (07:48):

Precision medicine, personalized medicine coming to sepsis. That's great to hear. Is the guideline you were talking about, is that a CHEST guideline that's being developed?

Angel Coz-Yataco, MD (07:57):

It is a chest guideline. It is something that a couple years ago we saw as a potential area that surviving sepsis does not necessarily cover, and we developed some pico questions to guide a little bit more in depth the hemodynamic management of patients with sepsis. [mm-hmm <affirmative>]

(08:16):

So we'll see what the evidence shows and if we can come up with recommendations. But even if there is no evidence for strong recommendations, I think what we can come up with is with suggestions for additional research to be done in the field. Because that's not only important, one, to motivate clinicians to do the research, but two, for funding agencies. Because once a guideline says that that's an area of need, it has a little bit more weight than if an investigator goes and says, this is what I want to do my research on.

Peter Mazzone, MD, MPH (08:46):

That's fabulous. It's great to hear that you moderated those abstract sessions too. The number of abstracts presented over the last couple of years has just, you know, really, really accelerated and it's nice to see the high quality clinical research part of the society. Some of those were, are new innovative things that you're talking about on how, Matt, any new and innovative topics that you got to sit in on?

Matt Siuba, DO (09:11):

Yeah, I think, you know, as a whole, the meeting this year was moving in a direction of trying to do more advanced sessions. So not just things that that are, you know, bread and butter topics encountered by pulmonary critical care physicians, but things that are a little bit more in depth. So it's kind of nice to see things that are more targeted towards, you know, advanced hemodynamics or, you know, management, for me, particularly person interested in right ventricular dysfunction. There was four or five sessions on RV dysfunction, which I think we would've never imagined before.

(09:37):

And then in terms of cutting edge research and things, it was nice to sit in some of the rapid fire sessions for research presentations here, things about like, you know, different types of catheter directed therapy for pulmonary embolism treatment and how thrombectomy may be more beneficial in things like catheter directed thrombolysis. A lot of really interesting things are happening and as Angel mentioned from younger and younger clinicians, that kinda makes me feel a little inadequate, but that's okay.

Peter Mazzone, MD, MPH (10:00):

Mm-hmm <affirmative>. That's great. Would, did you get a general sense of particular areas that might've been emphasized more than others, whether it's because there were new treatments that everybody needed to hear about or, or new guidelines that had been published for, Angel?

Angel Coz-Yataco, MD (10:19):

Yeah, so I agree with Matt that there has been more emphasis on the right ventricle. And part of that might be because CHEST has been part of set of guidelines published by a different society, but we had participation in those and we know that there's at least two more guidelines coming in that space. So because of that, there was probably a little bit more emphasis on pulmonary embolism and the different modalities.

(10:43):

There was also a lot of emphasis on the diseases that have newer agents available in the market for management, like the newer medications for pulmonary fibrosis or the newer medications for bronchiectasis. And also the new utilizations of some of the biologics that were traditionally used for asthma are now used for COPD. And I think, as I understand, there is more even in the pipeline that might be even provide more emphasis for those topics for the upcoming year.

(11:11):

So, and next year I'm actually have been invited back, I think they suspended me for a number of years from the product committee. [Mm-hmm <affirmative>] But somehow I think they're running thin of people they can call on, so they're calling me for next year. So I want to be part of that committee so hopefully can help shape a little bit of the program for next year, so.

Peter Mazzone, MD, MPH (11:29):

I think it was exciting to see all of the advances. There was, you know, energy in the meeting, not just from seeing all the advertising around, but it wasn't just the, what you were used to, you know, bronchodilator for this and that, but true progress in areas that have been difficult to crack - refractory COPD, you know, IPF progressing on a decade old drug. So this was an exciting time to be part of this meeting for sure.

(11:57):

Now, Matt, one topic that we hear at every single meeting and we, almost walking down the hall, you hear all the time is AI and AI developments and that. Did you see any sessions that introduced topics related to AI at all?

Matt Siuba, DO (12:11):

Yeah, it's funny. I don't think that I specifically attended any sessions that were, you know, this is AI and critical care, or AI and pulmonary, like you would've seen maybe in the past. What's interesting is it's kind of prevalent enough that it's infiltrated into all these different areas. It's just a part of the landscape of research and innovation in these fields. So instead of going to AI and critical care, it would be a talk on acute kidney injury and AI is part of the talk just because it's part of the research landscape right now. So it's kind of pervaded throughout, I think, all these different areas instead of just being a standalone talks like it used to be.

Peter Mazzone, MD, MPH (12:45):

Yeah, it's fascinating to see how various things enter the conversations year over year and what really dominates. And this year, I'd have to say AI, anything else from the AI standpoint that you were exposed to Angel?

Angel Coz-Yataco, MD (13:00):

Yeah, I know that there are, as Matt said, as opposed to having specific sessions on AI, there was, I think, a big incentive or a call for the people who wrote sessions, who submitted sessions to incorporate some elements of AI in their talk. I'm aware of a session in sleep medicine, which I mean I don't really know much about, but that had some elements of AI incorporated into that.

(13:24):

And there was, I'm aware there was a session specifically on AI, but I had a conflict with one of my sessions, so I couldn't attend. And also one thing that I saw that was very interesting, and I think something that is very useful for early career or fellows, executive fellowship, there was a session led by some of the members of our finance committee on how to understand your finances and also how to negotiate your first contract.

(13:51):

So I don't know if employers are gonna be too happy about that, but that is something that I think is a skill that we don't learn in medical school for sure, or during training. And as we are ready to leave the doors of our training place, we absolutely have no clue. And this is something that started, I think a couple of years ago, but because of how popular it was, it’s becoming more and more well attended.

Peter Mazzone, MD, MPH (14:13):

The meeting has always paid particular attention to the junior members of our community and found ways to make them feel welcome and provide them with very practical tips. So it's nice to hear that that's really continuing.

(14:27):

I was fortunate to be invited to an evening meeting of one of the bronchoscopy associations, and there were a few mentors of mine there. Dr. Mehta, Dr. Atul Mehta, from our organization gave a keynote talk and Dr. Jim Jett, a well-known thoracic oncologist who mentored much of the next generation of onco- pulmonologists, was there. And this is what makes these in-person meetings, I think, so valuable. You get to talk to people, meet people, maybe they're your mentees, maybe they're people you've done projects with.

(15:00):

Matt, did you have any time or experience with those sorts of meetings? Anyone you got to connect with?

Matt Siuba, DO (15:06):

Yeah, it seemed like every time I walked down the hall, I ran into one of our graduates, which was pretty nice to hear how people's careers are developing in really, you know, many different ways.

And then, you know, with our local team of trainees here, whether they be residents or fellows going and seeing them putting themselves out there with research and other types of presentations, it was really kind of motivating and nice to see. And as I already mentioned, you know, I was happy to see all these RV sessions.

(15:30):

One of the sessions was two out of the five presenters were graduates of our pulmonary critical care fellowship. [Mm-hmm <affirmative>] So that was really neat too. So it's nice to see people develop as they go. I'm fortunate since I trained here, I'm usually surrounded by my mentors as it is. So I'm a little lucky in that, but it's nice to see people as they've gone out and developed their own careers.

Peter Mazzone, MD, MPH (15:49):

It's really great to see the people you've worked with over time. One that I had been program director a while ago and one of the fellows at that time, her daughter is a sophomore at the University of Chicago, and my daughter's a freshman and they're just four floors apart and residents, I found out, being part of the meeting. Angel, did you have any experiences outside of the sessions?

Angel Coz-Yataco, MD (16:11):

Yeah, and it's always nice to look forward to going to the annual meeting and meeting people that you haven't seen for a year. In my case, it's a group that composes the board or some of the networks that we meet three or four times a year. But at the annual meeting, it's kind of the big party of the year, so where all the effort that was put throughout the year pays off.

(16:32):

And we have been fortunate that the meeting has been increasingly successful over the last few years. But in addition to that, I think one of the really rewarding experiences has seen how the involvement of fellows and faculty from our institution has increased. I think when I received the, because we received some sort of map of when the presentations of each of our faculty and fellows are, it's getting bigger and bigger as years go by.

And that's really nice to see because we have a lot of talent here and it's really nice how we can display that at the national, international level. And I don't know exactly the number, but it was at least 30 sessions that had a representative from our institution. And that's really nice to see.

(17:14):

And I think a lot of those started as fellows and now as they finish training now, they continue their involvement. I remember last year, two of our own, one a fellow Garra Manic [sp], he won an award from one of the networks, and the same with one of our staff, Priya [Bathmapriya Balakrishnan, MD, MS], also got an award from another network. So, I think that is something really nice to see, how they're getting involved and showing their talent at a national level.

Peter Mazzone, MD, MPH (17:43):

Yeah, it's very, very rewarding to see people grow through their careers. It makes you feel proud to be, you know, at a place like we're fortunate to be here in the Cleveland Clinic and for them to support our time and efforts that we give to these other organizations, like CHEST.

Angel Coz-Yataco, MD (17:59):

That makes you see how old you're getting, too. <laugh>.

Peter Mazzone, MD, MPH (18:01):

Oh, my goodness. That's for sure. That's for sure. Well, I really appreciate your guys' insights. It sounds like you had great meetings, as did I, and I look forward to talking to you again, maybe after next year's meeting.

Matt Siuba, DO (18:14):

Sounds great.

Peter Mazzone, MD, MPH (18:14):

All right guys.

Matt Siuba, DO (18:15):

Excellent.

Angel Coz-Yataco, MD(18:16):

The best, thanks Peter.

Peter Mazzone, MD, MPH:

Thank you.

Raed Dweik, MD(18:18):

Thank you for listening to this episode of the Respiratory Exchange podcast. You can find additional podcast episodes on our website, clevelandclinic.org/podcasts or wherever you get your podcasts.