Blair Westerly, Author at PulmCCM
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Blair Westerly

Blair Westerly, MD is a fellow in pulmonary and critical care medicine at the Mayo Clinic - Rochester.

Jan 192014
 
Macitentan for IPF falls short in MUSIC trial

Blair Westerly, MD Effective treatment for idiopathic pulmonary fibrosis continues to elude patients and clinicians alike.  Multiple classes of medications have been studied, none with convincing data demonstrating efficacy.  Because of the proposed  contribution of endothelin-1 to the pathogenesis of IPF, receptor antagonists of this growth factor have previously been evaluated in IPF, but with [... read more]

Jan 122014
 
Hypothermia might harm, not help, in bacterial meningitis

Hypothermia No Help for Bacterial Meningitis by Blair Westerly, MD Therapeutic hypothermia got “hot” after trials in the early 2000’s showed improvement in neurological outcomes in global cerebral hypoxia after cardiac arrest. (Any benefit of targeted temperature management below 36° Celsius is in serious doubt after a much larger randomized trial contradicted those earlier, smaller trials, showing no [... read more]

Apr 242013
 
Using procalcitonin to guide antibiotics for pneumonia

Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [... read more]

Apr 172013
 
How dangerous are ground glass nodules over time?

image: Radiology Assistant Ground-Glass Nodules: If Growing, Assume Cancer Blair Westerly, MD The more CT scans that are performed, the more ground-glass opacities (GGO’s) are seen and what to do with these abnormalities can be difficult to ascertain for clinicians. With the National Lung Cancer Screening Trial showing a mortality benefit from low dose CT [... read more]

Apr 112013
 
Obesity may improve survival in ARDS, but with renal failure

In ARDS, Obesity May Protect Life (But Not Kidneys) by Blair Westerly, MD Obesity is an epidemic and common in intensive care units in the United States.  Furthermore, while acute kidney injury (AKI) is also common in critically ill patients, obese patients carry additional risk for AKI because of increased baseline comorbidities. Both obesity and [... read more]

Apr 042013
 
Got sleep apnea? Climbing Everest? Pack your Diamox (RCT)

Acetazolamide Improved Obstructive Sleep Apnea at High Altitudes by Blair Westerly, MD Obstructive sleep apnea (OSA) is common, and so is travel to the mountains for work and play, therefore encounters with patients with OSA who travel to mountain destinations is not infrequent.  We all learn early in training that altitude affects oxygenation, and patients [... read more]

Mar 242013
 
Passive leg raise offers promise in predicting fluid responsiveness

“Like this … kind of” Passive Leg Raise Improved Management of Patients in Shock* (*some assembly required) by Blair Westerly, MD Providing the right amount of fluid is vital in a critically ill patient, as both too little and too much can result in poor outcomes. Yet even with this understanding, the clinical assessment of [... read more]

Mar 062013
 
Diuretics beat ultrafiltration at treating congestive heart failure with acute renal failure (RCT)

Ultrafiltration No Better Than Diuresis for CHF Exacerbations by Blair Westerly, MD Cardiorenal syndrome — simultaneous heart failure and renal failure — is a frequently encountered problem in people with acute decompensated heart failure.  Treatment with diuretics for congestive heart failure exacerbations is standard care, but diuretics may at times worsen renal function. Venovenous ultrafiltration [... read more]

Mar 032013
 
"Trach collar" beats pressure support trials for long-term ventilator weaning (RCT)

“Trach Collar” Trials Beat Pressure Support for Long-Term Ventilator Weaning By Blair Westerly, MD Patients requiring prolonged mechanical ventilation linger in ICUs and long-term acute care hospitals for weeks, accounting for a significant portion of intensive care unit costs and often suffering serious complications while dependent on the ventilator. Despite this issue’s rising importance, the [... read more]

Feb 212013
 
Intubation in pre-hospital cardiac arrest strongly associated with worse outcomes

Intubation for Out-of-Hospital Cardiac Arrest May Harm, Not Help by Blair Westerly, MD Out of hospital cardiac arrest is a major public-health problem, and despite advances in care, survival is still low. Improved survival has been associated with early CPR, rapid defibrillation, and integrated post cardiac arrest care, but pre-hospital “advanced airway management” (i.e., intubation [... read more]

Jan 312013
 
Etomidate associated with increased mortality in sepsis: meta-analysis

Etomidate: Unsafe for Intubation in Patients with Sepsis? by Blair Westerly, MD Etomidate is commonly used for rapid sequence intubation; however, even after one dose, it has been associated with adrenal axis suppression in critically ill patients. Though both adrenal insufficiency and increased mortality in sepsis have been associated with etomidate, the relationship of the [... read more]

Jan 242013
 
Continuing beta blockers safe during acute COPD exacerbations

Continuing Selective Beta Blockers Safe During COPD Exacerbations by Blair Westerly, MD Many COPD patients also have congestive heart failure or ischemic heart disease, two conditions where beta blocker therapy improves survival, but it has consistently been underutilized. The fear physicians have of instituting beta blockers in COPD is mostly secondary to the theoretical concern [... read more]