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Dec 182011
 

A 44-page guideline from the American Heart Association on the management of massive & submassive pulmonary embolism; proximal deep venous thrombosis, and chronic thromboembolic pulmonary hypertension. Circulation 2011;123:1788-1830. FREE FULL TEXT

Dec 082011
 

A handful of people with pulmonary embolism have absolute contraindications to anticoagulation. Authors here describe these as: Any prior intracranial hemorrhage, known structural intracranial cerebrovascular disease (eg, arteriovenous malformation), known malignant intracranial neoplasm, ischemic stroke within 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, recent surgery encroaching on the spinal canal or brain, [… read more]

Nov 132011
 

Research suggests e-cigarettes (those smokeless, cigarette-like nicotine delivery devices sold at convenience stores and elsewhere) can help people quit smoking, or at least dramatically cut back. So why does the FDA have a hatchet out for e-cigarettes — first trying to block their sale and distribution as illegal marketing of a drug delivery device — [… read more]

Nov 022011
 

A nice pro/con soundoff between Gerard Silvestri (con) and James Jett & David Midthun (pro) over whether lung cancer screening with chest CT should be national policy, in the wake of the positive findings of the National Lung Screening Trial. Silvestri (of MUSC) argues that we don’t have a handle on the harms of screening [… read more]

Oct 182011
 

This is a great article by a leader in the field (William Busse), and it’s free — you should download it and save it. His theme is “Filling in the information gaps,” and there are a lot of them. Filling them in will take a lot of time, funding, and a bigger shovel than anyone’s got right now. A [… read more]

Oct 142011
 

Here’s a free “head-to-head” discussion with arguments for and against implementation of routine mild hypothermia for all patients with out-of-hospital cardiac arrest. The benefits of hypothermia after out-of-hospital ventricular fibrillation cardiac arrests are reasonably well-established, and multiple society guidelines (SCCM’s, AHA’s) advocate the practice. The question is whether to induce mild hypothermia / targeted temperature management in all [… read more]

Oct 062011
 

Goncalves-Pereira and Povoa meta-reviewed 57 reviews of pharmacokinetics of common beta-lactam antibiotics (piperacillin, meropenem, cefepime, ceftazidime, etc.) on patients in ICUs. The results were troubling or at least confusing: studies reported wide variability in pharmacokinetics of beta-lactam antibiotics in critically ill patients, with volume of distribution and drug clearance varying more than 2-fold for the [… read more]

Sep 272011
 

Leukotrienes are important inflammatory mediators in both chronic asthma and acute exacerbations. Well-known for their benefits in the management of chronic asthma, leukotriene receptor antagonists haven’t been tested in acute asthma. Ramsay et al randomized 87 adults admitted to the hospital for asthma exacerbations to receive daily montelukast 10 mg or placebo for 4 weeks, [… read more]

Sep 272011
 

Perhaps the most contentious debate in critical care is whether and when to transfuse blood to patients, especially those with acute lung injury and/or septic shock. FACTT showed less fluids (which could include blood) are better for ALI/ARDS, but transfusion wasn’t controlled and its contribution to the outcomes is unknown. Practicing physicians vary widely in [… read more]

Sep 242011
 

Two kids under 5, one in Indiana and the other in Pennsylvania, have contracted a new reassorted swine flu: H3N2. The Pennsylvania child had had direct contact with a pig at an agricultural fair; the Indiana kid had been cared for by someone who had come in contact with a pig recently. Both children recovered [… read more]

Sep 172011
 

Surprisingly little is really known about airway remodeling in asthma, including its clinical course, or how treatment may modify it. Two examples: rather than occurring as a late sequela of unchecked inflammation, numerous recent studies show remodeling can occur in tandem with inflammation starting in early childhood. A recent NEJM article generates the hypothesis that [… read more]

Sep 102011
 

Asthma’s complex and protean inflammatory processes vary between individuals, some of whom have elevated levels of interleukin-13 despite maximal treatment with inhaled steroids. IL-13 prompts airway epithelial cells to secrete periostin, which acts on fibroblasts and may contribute to airway remodeling in asthma. Lebrikizumab is a monoclonal antibody inhibiting IL-13. Corren et al used a [… read more]

Aug 312011
 

Grijalva et al analyzed the Nationwide Inpatient Sample (data from U.S. hospitalizations) and found that the rate of hospitalization for parapneumonic empyema doubled from 3 per 100,000 in 1996, to 6 in 2008. The rate of empyemas due to Streptococcus pneumoniae was stable; the increases were in non-pneumococcal infections like Staphylococcus. Mortality was unchanged overall [… read more]

Aug 232011
 

An excellent free full text review by Paul O’Byrne. What’s new here: Did you know that formoterol is used as a first-line rescue inhaler, outside the U.S.? Formoterol has a steeper dose-response curve than salmeterol: repeated doses have an additive bronchodilator effect. The use of budesonide/formoterol as a combination maintenance AND rescue inhaler (added prn [… read more]

Jul 222011
 

Widespread beliefs among physicians that people with mental illness are more addicted, or less desirous or capable of quitting smoking, are wrong and perpetuate a deadly problem, argues J.J. Prochaska. You should nag mentally ill folks to quit smoking as you would anyone else, she urges. NEJM 2011;365:196-198. FULL FREE TEXT

Jul 202011
 

King et al report a series of 80 otherwise healthy young vets who failed a 2-mile run fitness test due to dyspnea at Fort Campbell, KY. Many had been exposed to sulfur fires or other inhalational exposures. Among 49 who underwent open lung biopsy, 38 had constrictive bronchiolitis, an extremely rare condition in otherwise healthy [… read more]