Use of BNP May Speed Weaning from Mechanical Ventilation by Blair Westerly, MD Weaning mechanical ventilation is a time-consuming process that is often impeded by volume overload. Minimizing fluid balance for patients on mechanical ventilation has been shown to decrease the duration of mechanical ventilation (Wiedemann et al). Brain natriuretic peptide (BNP) is released as [... read more]
Pulmonary Vasculitis Update / Review Part 2: Treatment and Prognosis (Go to Part 1: Clinical Features and Diagnosis) by Brett Ley, MD Treatment of the ANCA-associated pulmonary vasculitides consists of systemic corticosteroids and cytotoxic therapies given in two phases, induction and maintenance, where the aggressiveness of the regimen is based on disease severity. The standard [... read more]
Pulmonary Vasculitis Update / Review Part 1: Clinical Features & Diagnosis (Go to Part 2: Treatment and Prognosis) by Brett Ley, MD Vasculitides are disorders of inflammation and necrosis of the blood vessel wall. Pulmonary vasculitides can present in multiple ways: with alveolar hemorrhage, infiltrates, nodules, cavities, or airway disease. They are categorized by the [... read more]
Using BAL Cellular Analysis in Interstitial Lung Disease: 2012 ATS Guideline The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. An American Thoracic Society (ATS) expert panel including Keith Meyer, Ganesh Raghu, Brent Wood et al reviewed 35 years of published literature and [... read more]
This entry was originally posted March 10, 2012. Dr. Tobin made further comments to the AJRCCM in July 2012, which are excerpted below. Martin Tobin at Loyola University is worried about our standard practice in extubating patients. And since he wrote the book on mechanical ventilation and helped invent the Yang-Tobin index, if he’s worried, you [... read more]
GERD Treatment Improves Survival in Idiopathic Pulmonary Fibrosis? GERD is extremely common in people with idiopathic pulmonary fibrosis, and chronic microaspiration has long been suspected of playing a role in the pathogenesis of IPF. In a retrospective review, Joyce Lee, Jay Ryu, Harold Collard et al collected records on 84 patients with idiopathic pulmonary fibrosis [... read more]
Anemia in the ICU: 2012 Review (More 2012 Topic Updates) This document will be updated periodically to incorporate new research findings. To suggest an article for inclusion, please comment below. SUMMARY: Anemia is almost inevitable during many episodes of critical illness, and has been associated with worsened outcomes and prognosis. However, the preponderance of evidence suggests that correcting anemia [... read more]
(image: radpod.org) Restricting IV fluids for ARDS patients helps them get off the ventilator faster, in general. But a small follow-up study to the FACTT trial suggests that for some ARDS survivors, that approach may come at a cost of increased cognitive dysfunction for more than a year after hospital discharge. Since publication of the [... read more]
Alpha-1 Antitrypsin Deficiency: 2012 Review & Update More 2012 Topic Updates This alpha-1 antitrypsin review is periodically updated and reposted as new research findings are published. Alpha-1 antitrypsin deficiency is underrecognized and by implication undertreated, according to James Stoller and Loutfi Aboussouan of the Cleveland Clinic in their excellent concise clinical review in the Blue [... read more]
(image: K. Scott Richey) It’s not time to start checking the want ads just yet, and the Singularity may not be at hand, but make no mistake, fellow pulmonologists: the computers are gunning for our jobs. Or maybe it’s the surgeons who are tired of consulting us for “vent management,” and finding out we can’t [... read more]
Pulmonary Hypertension And Pulmonary Vascular Disease Review 2012 (More PulmCCM Topic Updates) This document is periodically updated as new research findings are published. The published date reflects the most current update. Please suggest articles for inclusion in future versions of this document in the comments or by e-mail. Chronic Thromboembolic Pulmonary Hypertension Update The mechanism [... read more]
Chronic obstructive pulmonary disease (COPD) was always believed to be a disease of progressive accelerated decline in lung function, even after quitting smoking. However, as it turns out, that time-honored (and still-taught) paradigm, based on some unsure assumptions and weak primary data, is not true. More recent investigations incorporating robust data sets from large populations [... read more]
Pneumonia and Respiratory Infections: 2012 Review (More PulmCCM Topic Updates) This review document on pneumonia and respiratory infections is updated periodically as new research findings are published. The listed date reflects its most recent update. Please suggest important articles for inclusion in future updates, either in the comments section below or by email. The Distal [... read more]
(image: GE) Exhaled Nitric Oxide Analysis for Respiratory Disease: ATS Guideline A blue ribbon panel led by Raed Dweik releases this ATS practice guideline, recommending when & how to use exhaled nitric oxide (FE-NO) for use in diagnosing and treating inflammatory respiratory conditions. FE-NO’s uses, they say, include: Predicting responsiveness to corticosteroid therapy Helping diagnose [... read more]
by Scott Aberegg, MD, MPH It is rare occasion that one article allows me to review so many aspects of the epistemology of medical evidence, but alas Schortgen et al afforded me that opportunity in the May 15th issue of AJRCCM. The issues raised by this article are so numerous that I shall make subsections for each one. [... read more]
Cystic Fibrosis 2012 Review (More 2012 Topic Updates) From the excellent summary by Felix Ratjen (U-Toronto) and Susanna McColley (Northwestern) in the May 2012 AJRCCM (Blue Journal), and our own cystic fibrosis literature review. Pulmonary Infection in Cystic Fibrosis The standard practice of early eradication of Pseudomonas aeruginosa in cystic fibrosis patients — giving inhaled [... read more]
Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA): 2012 Review (More 2012 Topic Updates) From concise clinical reviews by the don of cardiovascular disease, Eugene Braunwald (Harvard) in the May AJRCCM (Blue Journal) and Jeff Trost (Johns Hopkins) in Critical Care Medicine. These review articles on the diagnosis and treatment of non-ST-elevation acute coronary syndrome or NSTE-ACS (NSTE-myocardial infarction and unstable [... read more]
(image: nict.budocentral.com) Air pollution exposure seems to worsen lung function, and low-income children seem particularly vulnerable. One proposed reason for their susceptibility is co-exposure to high parental stress, which is worse in low-income families. Although that may sound hokey, psychosocial stress has been shown to increase oxidative stress, airway inflammation, and steroid resistance. (These findings [... read more]
(image: optimumchoices.com) In a surprise finding that could just maybe be written into a future sequel to Twilight, transfusing one pint of fresh-from-the-vein red blood cells was no better than using stale blood from the back of the fridge, at least in its effects on pulmonary, coagulation, and immunologic parameters 2 hours after transfusion. By [... read more]
Providing appropriate sedation and analgesia to mechanically ventilated patients is of paramount importance in the ICU. John P. Kress changed clinical practice for the better by showing that daily sedation interruptions (sedation vacations or sedation holidays) reduce ventilator days and mortality. He and Shruti Patel of the University of Chicago provide a fresh update on [... read more]