Update on tuberculosis: TB in the early 21st century. Connell DW et al, Eur Resp Rev 2011;20:71-84. FREE FULL TEXT
Improving survival after out-of-hospital cardiac arrest: AHA Consensus Statement. Neumar RW et al. Circulation 2011;123:2898-2910. FREE FULL TEXT. Guideline. Review.
The best approach to nutrition during critical illness is unknown. Casaer et al randomized 4,640 critically-ill patients who could not get enough calories by enteral feeding to receive TPN either on ICU day 3, or to wait until ICU day 8. While waiting for their TPN in the late group, patients got calories in sugar [... read more]
Flexible pressure CPAP reduces pressure briefly during expiration, to try to make it more comfortable. Bakker & Marshall meta-analyzed 10 randomized trials in >500 patients testing flexible pressure vs standard CPAP in people with obstructive sleep apnea; there were no differences in compliance or any other outcome. CHEST 2011;139:1322-1330.
Schuchert et al looked back at 107 patients with stage IA subcentimeter non-small cell lung cancer, and found that 5-year survival was similar (~88%) for those undergoing wedge resection (n=35), segmentectomy (n=40), or lobectomy (n=32). Ann Thorac Surg 2011;91:1681-1688.
Zager et al examined registry data on 38,917 patients admitted to Beth Israel and Brigham & Women’s hospitals between 1997-2007, and concluded that low socioeconomic status (as determined by census tract neighborhood of residence) did not influence 30- or 365-day mortality after admission to these hospitals’ ICU. CHEST 2011;139:1368-1379.
Hargreave and Nair (PRO) argue the boutique technique is underrated and underused, citing trials showing improvement in severe asthma outcomes when sputum eosinophils are used to guide therapy (1, 2, and studies on IL-5 blockers). Peters (CON) questions the findings of those trials, doubts eosinophil count adds to clinical measures of asthma control, and compares [... read more]
Peacock et al randomized 226 people in 13 US EDs to either IV nicardipine or IV labetalol for hypertensive emergency (SBP ~215). More patients receiving nicardipine achieving their target BP range within 30 minutes (92% vs. 83%). (n=226) Critical Care 2011;15:R157. FREE FULL TEXT
Wrist actigraphy: Martin JL, Hakim AD. CHEST 2011;139:1514-1527.
That’s what Banerjee et al argue, after retrospectively comparing ICU costs before/after implementation of 24-hour in-house intensivist coverage. They found that total costs for patients admitted at night declined by 61%, while daytime costs were unchanged. Crit Care Med 2011;39:1257-1262.
New York’s city council banned smoking in almost all public spaces on May 23. Colgrove et al raise the interesting point that because the risk from secondhand smoke outdoors is nil, the political move oversteps the mandate of public health, and is instead heavyhanded social engineering that will further stigmatize smokers, a sad and addicted [... read more]
Potential metabolic consequences of statins in sepsis. Brealy DA et al. Crit Care Med 2011;39:1514-1520.
The UK has only one-seventh the number of ICU beds per capita as the US, which surely must affect care delivery. Wunsch et al examined 172,785 ICU admissions in the Project IMPACT database (US) and the Case Mix Programme (UK). It appeared harder to get into an ICU in the UK (from the ER or [... read more]
Ruiter et al showed that 30 of 70 (43%) Dutch patients with idiopathic pulmonary arterial hypertension were iron deficient, and had lower 6-minute walk distances (390 vs. 460 m), regardless of whether anemia was present. Eur Resp J 2011;37:1386-1391.
Pulmonary alveolar proteinosis. Borie R et al, Eur Resp Rev 2011;20:98-107.
Menthol doesn’t kill people — cigarettes that are tastier and easier to smoke because of menthol do. The FDA’s Tobacco Products Scientific Advisory Committee blandly concluded that removing menthol from cigarettes would improve public health, but in the current pro-economic recovery environment, there is no political will to take on Big Tobacco, Siegel, Benowitz and [... read more]
In severe congestive heart failure, lymphatic drainage can increase 10-fold. Pastis et al hypothesize this could result in enlarged mediastinal lymph nodes. They retrospectively examined chest CT scans for 118 patients undergoing heart transplantation. Fifty-three had mediastinal LNs > 1 cm. In the 9 who had post-transplant CT scans available, mediastinal lymph nodes shrank after [... read more]
Masclans et al followed 38 patients with ARDS in 3 ICUs for 6 months. Health-related quality of life (Nottingham Test Profile) was lower than expected at 6 months, with 40% reporting limitations in daily activities mainly due to low energy, mobility and social functioning. Mild radiographic abnormalities and restrictive physiology were usually present on HRCT [... read more]
Wilson & Schuneman examine the evidence forming the basis for performance measures for community acquired pneumonia, and found it to be generally poor. Did the performance measures hold water? Pneumovax: weak yes (extremely low absolute effect). Blood cultures: too weak to say. Smoking cessation counseling: no. Antibiotics in 6 hours: very weak yes. Guideline-compliant antibiotics: [... read more]
van der Aalst et al report that in the Dutch lung cancer screening NELSON trial, smokers with 1 or more indeterminate CT scans continued to smoke at the same rate as those with normal CT scans (reported by questionnaire 2 years later). Those with the abnormal CTs did report more attempts at smoking cessation, though. [... read more]