Society Journal 1 Archives - Page 3 of 8 - PulmCCM
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Society Journal 1 Articles

Apr 222012
 
Should you check pleural manometry during thoracentesis? (Pro/Con, Chest)

(image: Cardinal Health) Should you routinely check pleural pressures with bedside manometry during thoracentesis? David Feller-Kopman of Johns Hopkins says, of course: it’s zero risk, zero cost, only seconds of extra time, and provides potentially useful clinical information. Specifically, one can identify people with “entrapped lung” and “trapped lung”: Identifying “Entrapped Lung” by Pleural Pressures [... read more]

Apr 212012
 
Pneumothorax in the ICU (Review, Chest)

From the excellent review by Lonny Yarmus and David Feller-Kopman in the April 2012 Chest, along with the British Thoracic Society and ACCP’s consensus statements: Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the [... read more]

Mar 242012
 

(Comments by first author James T. Good follow this post.) For 58 patients with refractory asthma at National Jewish, James Good et al devised a systematic, bronchoscopy-driven approach that they feel resulted in improved asthma symptoms and identification of potential phenotypes of refractory asthma among the enrolled subjects. Their methodology was highly detailed and time- and labor-intensive. It included using [... read more]

Mar 112012
 

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Mar 082012
 
Obstructive sleep apnea increases risk for postop complications (CHEST)

Mayo investigators reported back in 2001 that people with obstructive sleep apnea had a higher rate of perioperative complications including hypoxia and longer lengths of stay. Since then, there have been other signals that this is a real phenomenon, but perhaps surprisingly, the evidence hasn’t exactly piled up to unequivocally prove the intuitive point. That’s [... read more]

Mar 022012
 
Walk to wean: Early mobilization for ventilated patients (Review, CHEST)

Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress and William Schweickert have turned their attention to early mobilization as the next intervention that could help mechanically ventilated patients escape the ventilator faster. [... read more]

Feb 292012
 
"First dibs" on patients by sleep docs increased CPAP adherence (CHEST)

In the face of criticism from insurers and the government for a perceived excessive zeal for profits, and mounting evidence that uncomplicated obstructive sleep apnea (OSA) can be diagnosed at home and managed by primary physicians, you can’t blame sleep specialists for feeling down-in-the-mouth lately. Sushmita Pamidi et al report some brighter news in the [... read more]

Feb 262012
 

I knew I smelled something fishy about this paper when I read and commented on it last year.  Now, Chest reports they’re giving this study a burial at sea, after the authors could not produce actual data supporting the trial. To help set the record straight: Chest published a retrospective study in March 2011, “Chest Tube [... read more]

Jan 272012
 

C. difficile has always been a foul and disgusting adversary, but lately it’s becoming more formidable and deadly, according to Linda Bobo, Erik Dubberke and Marin Kollef. A few highlights of this excellent review: C.diff infections (CDI) have more than doubled since 2001, to > 340,000 discharges in 2008. Attributable mortality is 6-7%, but may [... read more]

Jan 212012
 
Omitting heparin prophylaxis in first 24 ICU hours associated with higher mortality (CHEST)

As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [... read more]

Jan 152012
 

Himani Gupta, Prateek Gupta, and Lee Morrow of Creighton have done us all a favor by mining a national database (the National Surgical Quality Improvement Program) to create and validate a risk calculator for perioperative pulmonary complications, which they unveil in the November CHEST. Pulmonologists are consulted every day to weigh in on the risk [... read more]

Jan 122012
 
How to cure abdominal compartment syndrome without surgery (CHEST)

Intra-abdominal hypertension (defined as a sustained urinary bladder pressure > 12 mm Hg) may be an under-recognized problem in the ICU, especially in patients after abdominal surgery or who have gone massive volume resuscitation with blood and/or fluids (think hemorrhage, burns and sepsis). When high abdominal pressures (> 20 mm Hg sustained) cause organ failure and/or [... read more]

Jan 082012
 
Early tracheostomy doesn't improve outcomes ... much (Meta-analysis, CHEST)

[poll id="3"] A 2005 meta-analysis of 5 studies (n=406) concluded that early tracheostomy reduced need for mechanical ventilation and ICU days. But then a 2006 randomized trial in trauma patients found no benefit to early trach, and an underpowered 2008 RCT also found no benefit. In a new meta-analysis and systematic review of 7 trials (n=1,044), Fei [... read more]

Jan 082012
 
Elderly critically ill who survive ICU rationing live well (CHEST)

Many argue that as a limited resource serving unlimited needs, medical care is “rationed” by definition, and ICU resources (being more limited and expensive) are simply more overtly rationed. For example, in France, ICU admission is often denied to the very elderly critically ill, explicitly because of their age (this happens in the U.K., too, probably). In the U.S., [... read more]

Jan 072012
 

One thing I thought I knew was that overweight and obesity cause coronary artery disease and make it worse. People with CAD who are obese should lose weight … right? Recent research shows it’s not that simple (although the answer is still “yes, probably”). Did you know about the “obesity paradox?” Or the “lean paradox,” [... read more]

Jan 012012
 

Ultrasound is the future. It’s even better than that: it’s the present. So say proponents Seth Koenig, Mangala Narasimhan and pioneer & innovator Paul Mayo in this month’s CHEST review. They endorse a “paradigm shift” meaning, in effect, you get professionally trained on this highly versatile, effective, and immediate-results-providing modality and integrate it into your routine [... read more]