CHEST Guidelines-Response_chest

Response_chest_6

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The document is a collection of communications between healthcare professionals, primarily focusing on the use of lung ultrasonography (LUS) in diagnosing neonatal lung conditions and the management of inferior vena cava (IVC) filters. Dr. Jing Liu responds to comments made by Dr. Marco Sperandeo and colleagues regarding a study on LUS for transient tachypnea of the newborn (TTN). Liu acknowledges the insights provided by Sperandeo et al., recognizing the potential of LUS in accurately diagnosing lung diseases, yet highlighting some differing opinions. Liu emphasizes that LUS is notably more effective than chest radiography in detecting neonatal pulmonary atelectasis, particularly in identifying occult lung atelectasis which might be missed in radiographic examinations. He argues that LUS’s superior sensitivity warrants consideration for replacing radiography, especially in neonatal wards, and highlights the nuanced differences in ultrasound characteristics, such as the distinction between pneumonia and atelectasis.<br /><br />Additionally, an editorial by Drs. Arous and Messina about IVC filters is critiqued, suggesting an overly generalized approach to filter removal. It underscores the need to differentiate between high-risk and low-risk populations when considering filter removal, emphasizing that while the complication risk of IVC filters might be consistent across all patients, their benefit is dependent on individual patient risk profiles. The article points out the reduced risk of pulmonary embolism (PE) associated with the use of IVC filters as demonstrated in studies cited by the authors, criticizing the lack of a standardized measure of risk in case reports which often drives decisions. It calls for clearer, evidence-based distinctions for managing patients with a history of venous thromboembolism (VTE) and states that current guidelines support filter retention in patients at high risk for PE, contrasting this with FDA advice aimed at lower-risk patients.

Keywords

lung ultrasonography

neonatal lung conditions

inferior vena cava filters

transient tachypnea of the newborn

neonatal pulmonary atelectasis

pneumonia vs atelectasis

pulmonary embolism

venous thromboembolism

radiography replacement

risk profiles