ATS 2019 Virtual Final Program

2:53 CON: Systemic Thrombolysis Has No Role in Submassive PE L.K. Moores, MD, Bethesda, MD 3:01 Rebuttal: Systemic Thrombolysis for Submassive PE Improves Outcome D. Jimenez, MD, PhD, Madrid, Spain 3:05 Rebuttal: Systemic Thrombolysis Has No Role in Submassive PE L.K. Moores, MD, Bethesda, MD 3:09 Question and Answer Session: Systemic Thrombolysis for Submassive PE R.N. Channick, MD, Boston, MA 3:15 PRO: Push Dose Thrombolysis Saves Lives in Massive PE with Cardiopulmonary Collapse B.N. Rivera-Lebron, MD, MS, Pittsburgh, PA 3:23 CON: There Are Better Ways to Handle Massive PE Patient with Hemodynamic Collapse B. Keeling, MD, Atlanta, GA 3:31 Rebuttal: Push Dose Thrombolysis Saves Lives in Massive PE with Cardiopulmonary Collapse? B.N. Rivera-Lebron, MD, MS, Pittsburgh, PA 3:35 Rebuttal: There Are Better Ways to Handle Massive PE Patient with Hemodynamic Collapse B. Keeling, MD, Atlanta, GA 3:39 Question and Answer Session: Hemodynamically Unstable Massive PE Management R.N. Channick, MD, Boston, MA 3:45 PRO: IVC Filter is Dead in PE Management S. Naydenov, MD, St. Louis, MO 3:53 CON: IVC Filter is Critically Ill But Not Dead in PE Management P. Rali, MD, Philadelphia, PA 4:01 Rebuttal: IVC Filter is Dead in PE Management S. Naydenov, MD, St. Louis, MO 4:05 Rebuttal: IVC Filter is Critically Ill But Not Dead in PE Management P. Rali, MD, Philadelphia, PA 4:09 Question and Answer Session: Role of IVC Filter in PE Management R.N. Channick, MD, Boston, MA CLINICAL CLINICAL TOPICS IN PULMONARY MEDICINE CME Credits Available: 2 MOC Points Available: 2 B83 MANAGEMENT OF NEUROMUSCULAR RESPIRATORY FAILURE SYNDROMES: NIPPV FOR DAY, NIGHT AND THE SOCCER FIELD Assemblies on Sleep and Respiratory Neurobiology; Clinical Problems; Pediatrics 2:15 p.m. - 4:15 p.m. KBHCCD Ballroom C Three-Four (Level 2) Target Audience Adult and pediatric pulmonary and sleep physicians and mid-level providers working with patients with neuromuscular respiratory failure, nurses and respiratory therapists Objectives At the conclusion of this session, the participant will be able to: • recognize clinical, PFT and PSG findings of respiratory muscle weakness in neuromuscular disease in pediatric and adult population; • identify and define the stages of neuromuscular respiratory failure and the stepwise implementation of assistive devices of respiration and airway clearance; • learn options for (1) optimizing home-based NIPPV (2) when to extubate neuromuscular patients who fail conventional spontaneous breathing trials/sprints and (3) when/if tracheostomy should be employed. Patients with pediatric neuromuscular disorders (muscular dystrophies, spinal muscular atrophy, metabolic myopathies) are surviving longer, and are requiring adult pulmonary providers to effectively transition care. The adult onset neuromuscular disorders are also increasing in prevalence (amyotrophic lateral sclerosis) and survival with advancing technologies in airway clearance and non-invasive ventilation (NIV). The session will address identification of and stage of neuromuscular respiratory failure, implementation of stage specific respiratory assistive devices to maximize patient independence, quality of life and survival, home monitoring and returning these patients to non-invasive ventilation after periods of invasive mechanical ventilation. We will also discuss the hot button issues of if/when tracheostomy and oxygen supplementation fit into the treatment paradigm, and how overnight polysomnography may be helpful in optimizing NIV. Chairing: K.A. Provost, DO, PhD, Buffalo, NY N. Simakajornboon, MD, Cincinnati, OH M. Cao, DO, Redwood City, CA H. Sawnani, MD, Cincinnati, OH 2:15 Neuromuscular Respiratory Failure Syndromes: Recognition is Half the Battle H. Sawnani, MD, Cincinnati, OH 2:33 Mechanisms of Hypoxemia and Hypoventilation in Neuromuscular Respiratory Failure G. Perez, MD, Washington, DC 2:51 Implementation of NIPPV and Airway Clearance Devices by Disease Stage K.A. Provost, DO, PhD, Buffalo, NY 3:09 Sleep Disordered Breathing in Neuromuscular Respiratory Failure: The Role of the Overnight PSG, Overnight Transcutaneous CO2 and Oxygen Testing M. Cao, DO, Redwood City, CA 3:27 Them’s Fighting Words: Hot Button Issues of Extubating the “Un-Extubatable” Patient, Tracheostomy Considerations and Oxygen Supplementation D. Zielinski, MD, Montreal, Canada 3:45 Daytime Use of NIPPV: Sip and Beyond L.F. Wolfe, MD, Chicago, IL 4:03 Panel Question and Answer with all the Speakers ATS 2019 • Dallas, TX MONDAY • MAY 20 199 MONDAY AFTERNOON