Recommendations were graded according to CHEST s grading system, which uses the GRADE approach (Table 2).11,12 The recommendations were either strong or weak according to this approach. Strong recommendations use the wording we recommend and weak recommendations use the wording we suggest. The implications of the strength of recommendation are summarized in e-Table 2. In instances in which there was insuf cient evidence, but a clinically relevant area was felt to require a guiding comment, a weak suggestion was developed and Ungraded Consensus-Based Statement replaced the grade.13 In developing our treatment recommendations, we attempted to account for patient values and preferences regarding these outcomes, and had 2 patient advocates (Mellanie True Hills and D. A. L.) who participated in the panel discussion, and speci cally addressed patient-centered issues. Consensus Development All drafted recommendations and suggestions were presented to the panel in an anonymous online voting survey to reach consensus and gather feedback. Panelists were requested to indicate their level of agreement on each statement based on a 5-point Likert scale derived from the GRADE grid.14 Panelists with COIs related to the individual recommendations recused themselves from voting on those statements. Of note, the chair (G. Y. H. L.) recused himself from any voting on recommendations. According to CHEST policy, each recommendation and statement required a 75% voting participation rate and at least 80% consensus to pass. Any recommendation or suggestion that did not meet these criteria was revised by the panel based on the feedback, and a new survey that incorporated those revisions was completed. Peer Review Process Reviewers from the Guideline Oversight Committee, the CHEST Board of Regents, and the CHEST journal reviewed the methods used and the content of the manuscript for consistency, accuracy, and completeness. The manuscript was revised according to feedback from the reviewers. 