CHEST Guidelines-Response_chest

Response_chest_30

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The document comprises two letters to the editor featured in the journal <em>Chest</em>. The first letter addresses the ongoing debate about the adoption of pulmonary concierge practices, as discussed in articles by Freedman and Foreman et al. The authors, Foreman and Flenaugh, appreciate feedback from Drs. Alrajab and Uysal, acknowledging the shared goal of health equity. They emphasize the inadequacy of merely "encouraging" community clinics for achieving equitable access and argue that financial incentives are stronger motivators for practitioners. They discuss concerns about health equity in systems adopting concierge-like practices, noting that placing financial barriers undermines equity. While not entirely opposing concierge practices, they suggest cautious consideration of their broader implementation.

The second letter praises a study by Semler et al. on intubation positioning in the ICU. While the study investigated optimal patient positioning during intubation, it did not provide insights on improvements in oxygenation through semi-sitting or ramped positions. They note that experimentally, patients experience slower desaturation in these positions due to diaphragm displacement, which increases lung capacity. However, in this study, no benefits in reducing oxygen desaturation were observed for patients in the ramped group, likely due to a higher proportion of difficult airways, resulting in more extended intubation times. The authors highlight the importance of airway positioning but caution against this study's applicability due to the disparity in intubation difficulty across groups.

Both letters underline the importance of equity and careful evaluation in implementing medical practices, whether they concern concierge models or clinical procedures in critical care settings.

Keywords

pulmonary concierge practices

health equity

financial incentives

community clinics

concierge-like practices

intubation positioning

ICU study

oxygen desaturation

airway positioning

critical care