CHEST Guidelines-Endoscopic-Ultrasound-Training-for-Pulmonologists

Endoscopic-Ultrasound-Training-for-Pulmonologists_

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The document discusses two main topics: the use of midodrine during recovery from septic shock and the training of pulmonologists for endoscopic ultrasound (EUS).<br /><br />Firstly, it reports on a study comparing the effectiveness of intravenous vasopressors with and without midodrine for patients recovering from septic shock. The median APACHE IV scores, which measure illness severity, were similar between groups (83 for IV vasopressor-only and 77.5 for the group with midodrine, P = .55). Eighteen patients were discharged on midodrine, with seven going to hospice care and others to various facilities, indicating diverse treatment approaches. There's a recommendation against routine outpatient midodrine use during septic shock recovery, emphasizing careful decremental titration of the drug to monitor for hypotension.<br /><br />Secondly, the text discusses the value of training pulmonologists to perform EUS, highlighting its benefits over traditional bronchoscopy, especially for patients with severe COPD. EUS provides similar diagnostic yields but fewer complications like anesthetic usage and oxygen desaturation. The text advocates for pulmonologists, rather than gastroenterologists, to perform EUS, due to their familiarity with mediastinal anatomy, which can be crucial for staging lung cancer. A training protocol that includes learning the ultrasound anatomy of the mediastinum and acquiring practical skills in EBUS (endobronchial ultrasound) is encouraged to expand the use of EUS.<br /><br />In summary, the document outlines findings on midodrine's use post-septic shock and the call for specialized training in EUS for pulmonologists to improve diagnostic capabilities and patient care in lung cancer staging.

Keywords

midodrine

septic shock

intravenous vasopressors

pulmonologist training

endoscopic ultrasound

COPD

bronchoscopy

mediastinal anatomy

lung cancer staging

endobronchial ultrasound