20% of U.S. deaths now occur during or soon after an ICU stay — but the families live on, often with upsetting memories, depression, and anxiety. Kross et al re-heat data from the IPACC palliative care study in Washington, surveying family members of ICU decedents, showing they had a 14% prevalence of PTSD symptoms and 18% of [... read more]
Probiotics and lung diseases: Forsythe P, CHEST 2011;139:901-908.
Pseudomonas pneumonia: Epidemiology, clinical diagnosis, source (Part 1) Fujitani S et al, CHEST 2011;139:909-919.
Sleep medicine, a 3,000-year history: Kirsch DB, CHEST 2011;139:939-946.
Tako-tsubo cardiomyopathy, natural history of: Parodi G et al, CHEST 2011;139:887-892.
Fang et al prospectively observed 126 patients undergoing lung transplant at 9 U.S. centers. PA pressure was obtained invasively in the OR just after transplant. Those who developed grade 3 primary graft dysfunction at 72 hours (1′ endpoint) had mPAP of 38.5 mm Hg, compared to 29.6 for those who did not; the relationship persisted [... read more]
Psychiatrist Aaron Lazare from U-Mass has been writing and thinking about humiliation in medical education and practice for years. This engrossing article exposes the destructiveness and persistence of this toxic emotion that he argues is sadly endemic in our profession. CHEST 2011;139:746-751.
Long-term oxygen therapy: Christopher KL & Porte P, CHEST 2011;139:430-440
THIS STUDY HAS BEEN RETRACTED. Kupfer et al looked retrospectively at 168 vented patients with transudative pleural effusions at Maimonides in Brooklyn. The half that got chest tubes (with an average of 1,200 mL drained) spent 3.8 days on the vent, vs 6.5 days for the group that got only thoracentesis, with no complications reported. [... read more]
Autonomy and beneficence, a historical perspective. Will JF, CHEST 2011;139:669-673. ICU ethics review.
Critical care for patients with stroke. Lukovits TG, CHEST 2011;139:694-700.
Occupational asthma – Assessment, treatment, compensation: Cowl TC, CHEST 2011;139:674-681.
Tashkin et al randomized 504 patients at 27 centers with COPD and FEV1 > 49% to varenicline or placebo for 12 weeks, with 52 weeks follow up. Smoking cessation / abstinence rate (carbon monoxide-confirmed) was 42% vs 9% in weeks 9 – 12 (1′ endpoint), and 19% vs. 6% in weeks 9 – 52 (p<0.0001). [... read more]
Aduen et al performed simultaneous echocardiograms and right heart catheterizations on 117 patients, concluding echo is more accurate and precise than others previously found. They also promote a method of calculating and reporting mean PA pressure on echo, rather than systolic PA pressure. Right heart catheterization remains indispensable as the gold standard. CHEST 2011;139:347-352
Pulmonary Complications of Lung Transplantation: Ahmad, CHEST 2011;139:402-411.
Ciclesonide, a new inhaled corticosteroid that seems to cause thrush less often than others, reached for equivalency with salmeterol/fluticasone in mild persistent asthma. Ciclesonide was better than placebo in controlling asthma but Advair users had a longer time to first asthma exacerbation. CHEST 2011;139: online supplement. A Cochrane review on ciclesonide could not establish its [... read more]
Patients with on-site evaluation of TBNA samples had fewer sites sampled (1 vs. 2) and general complications (6% vs. 20%), with an equivalent yield compared to patients undergoing usual TBNA (n=168). CHEST 2011;139:395-401.
Priou et al followed 130 patients with OHS after initiation with noninvasive positive pressure ventilation. Mean follow up was 4 years. Most (96) were started on NPPV in the stable state; 38 had had an acute hypercapneic exacerbation. Survival at 1 year was 97.5%; 2 years (93%); 3 years (88%); 5 years (77%). The large [... read more]
In case there was any question, no you can’t use the femoral vein to collect ScvO2 samples. Davison et al found a bias of 4% between femoral and nonfemoral sources in 39 critically ill patients (with an interestingly wide standard deviation of 12% in blood obtained from either source). In more than half the patients, [... read more]
Cavallazzi et al reviewed 10 cohort studies and concluded that compared to daytime admission, being admitted to an ICU at night did not increase the odds ratio for mortality. Being admitted on a weekend supposedly did, but the odds ratio was only 1.08. CHEST 2010;138:68-75. FREE FULL TEXT