CHEST Guidelines-Extracorporeal-Membrane-Oxygenation-for-Myositis-A

Extracorporeal-Membrane-Oxygenation-for-Myositis-A

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The correspondence delves into discussions surrounding patient health data utilization, frailty assessments, and treatment strategies involving Extracorporeal Membrane Oxygenation (ECMO) in myositis-associated rapidly progressive interstitial lung disease (RP-ILD).<br /><br />The initial section highlights the importance of comprehensive geriatric assessments like the interRAI system, which enables detailed evaluations necessary for frailty measurements. Contributing authors argue these assessments are not "low-granularity" as previously contended, emphasizing their use in acute and home care settings to assist in predictive frailty models following hospital discharge.<br /><br />A separate debate emerges from a study by Rubin et al. on ECMO's effectiveness in treating RP-ILD, focusing on different myositis classifications that affect treatment outcomes. Authors critique the utility of veno-venous ECMO (VV-ECMO) given its high cost and variable prognosis, suggesting the need for targeted therapeutic approaches depending on the specific type of myositis present, notably differentiating between antisynthetase syndrome and anti-MDA5 RP-ILD. There's also discourse on appropriate therapeutic regimens and discussing newer strategies like bridge-to-transplantation in cases where ECMO cannot sustain recovery.<br /><br />In response, Rubin et al. caution against overgeneralizing results due to variability in myositis presentations and highlight diagnostic challenges in recognizing RP-ILD, which is often misclassified as ARDS. This misclassification can complicate treatment planning, entailing that diagnoses, including specific antibody statuses, often occur post-cannulation rather than prior.<br /><br />The converging insights denote critical reflections on implementing personalized health strategies and emphasize coordinated diagnostic and therapeutic pathways, especially when dealing with complex, multifaceted diseases like RP-ILD.

Keywords

patient health data

frailty assessments

ECMO

myositis-associated RP-ILD

interRAI system

predictive frailty models

veno-venous ECMO

antisynthetase syndrome

anti-MDA5 RP-ILD

personalized health strategies