CHEST Guidelines-A-24-7-Pilot-Remote-Emergency-Multidisciplinary-Di

A-24-7-Pilot-Remote-Emergency-Multidisciplinary-Di

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The document details a pilot project initiated in October 2021 for managing rapidly progressive interstitial lung disease (RP-ILD) through a 24/7 multidisciplinary discussion (MDD) platform. ILDs are rare with complex diagnoses, requiring prompt interventions due to their rapid progression, often linked to conditions such as connective tissue diseases and idiopathic inflammatory myopathies. This innovative French-speaking project was devised to expedite diagnosis and treatment, particularly in urgent cases, using remote videoconferencing.<br /><br />The 24/7 MDD involved a quorum of specialists, such as pulmonologists, internists, and lung transplant experts, to discuss RP-ILD cases when summoned by attending physicians. Over 26 months, 26 patients were discussed. Typically, these patients were severely ill, often admitted to intensive care units and requiring invasive support measures. The most common diagnosis was anti-MDA5 dermatomyositis-related RP-ILD, identified in 54% of cases.<br /><br />The MDD allowed for timely expert recommendations, often advising on escalating treatments including the use of immunosuppressants. Emergency lung transplantation was considered for 73% of the patients, highlighting its potential as a critical intervention avenue. However, only a small fraction proceeded to transplantation due to various constraints.<br /><br />The study concludes that the 24/7 MDD has proven feasible, with significant specialist engagement and rapid response capability. It addresses critical management challenges in RP-ILD by ensuring immediate access to specialized expertise and potentially enhancing therapeutic strategies. Despite its successes, the study notes limitations such as the small patient cohort and reliance on expert opinion due to the lack of high-quality evidence. Future worldwide adoption and corresponding studies could refine these approaches, ultimately improving RP-ILD outcomes.

Keywords

RP-ILD

multidisciplinary discussion

24/7 MDD platform

interstitial lung disease

connective tissue diseases

remote videoconferencing

anti-MDA5 dermatomyositis

emergency lung transplantation

immunosuppressants

therapeutic strategies