JAMA Archives - PulmCCM
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JAMA Articles

Jul 172015
 
Recurrent PE risk after long-term warfarin therapy remains high (PADIS-PE)

Not long ago, doctors were taught that 6 months of anticoagulation was plenty for patients with unprovoked pulmonary embolism. That standard was never based on long-term outcomes studies. And as longer-range data started to come in — gulp — it was clear that large numbers of people treated with 6-month warfarin courses after unprovoked PE [… read more]

Jul 012015
 
Families stall end of life talks, say doctors. True?

Doctors and nurses said patients and their families created the largest obstacles to end-of-life decision making in the ICU, in a large survey published in JAMA Internal Medicine. About 1,300 staff at 13 academic hospitals in Canada rated barriers to end-of-life goals of care on a 1-7 scale. Doctors and nurses considered the largest barriers [… read more]

Mar 062015
 
Chlorhexidine baths in ICU don't prevent infections in large trial

Throwing the Baby out with the (Chlorhexidine) Bathwater? New Data on Disinfectant Baths By Lekshmi Santhosh, MD As a critical care community, we’ve been forever searching for a magic bullet to eradicate healthcare-acquired infections. So when the pair of 2013 NEJM trials on daily chlorhexidine bathing showed statistically significant reductions on the incidence of hospital-acquired [… read more]

Feb 192015
 
Chantix works even if you're just thinking of quitting smoking

“Set a quit date to stop smoking,” goes the old bit of doctor’s advice. Experts argue people need to psyche themselves up, get serious, commit to quitting before the last butt goes in the ashtray. A new study in JAMA suggests that advice may be outdated. Smokers unready to quit who took the cessation drug varenicline (Chantix) for several months, [… read more]

Sep 122014
 

All the best in the pulmonary and critical care medicine literature from our ongoing journal survey. Browse all the PulmCCM Roundups to stay up to date. Thrombolytics for Pulmonary Embolism: New Metaanalysis Most patients with massive pulmonary embolism (PE with shock) should receive thrombolytics, but it’s unclear from randomized trial data which patients with submassive pulmonary embolism [… read more]

Jul 202014
 
PulmCCM Roundup #5

The PulmCCM Roundup gathers all the best in pulmonary and critical care from around the web.  Browse all the PulmCCM Roundups. Statins Fail for COPD, ARDS Statins have been optimistically tested as a tonic for everything from diabetes to dementia — so far, without success. That consistency was maintained in 2 recent trials showing statins’ [… read more]

Jun 272014
 
Azithromycin for COPD exacerbations: 2014 Update

Azithromycin to Prevent COPD Exacerbations: What’s New? By Abhishek Biswas, MD Multiple previous studies have suggested likely benefits from using azithromycin as an immunomodulator for cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, post-transplant obliterative bronchiolitis and COPD. This month, a new Cochrane analysis and clinical review in JAMA concludes that “continuous macrolide antibiotic use for prophylaxis [is] associated with a [… read more]

Jun 082014
 
PulmCCM Roundup #4

All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Asthma Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does seem to improve [… read more]

May 082014
 
Red blood cell transfusions increase hospital-acquired infections (meta-analysis)

Red Cell Transfusions Increase Risk for Nosocomial Infection: Meta-Analysis Transfusing blood to anemic patients has an almost irresistible intuitive and theoretical appeal both to physicians and the patients who get transfused. It’s perhaps the archetypal example of the “find it – fix it” approach to doctoring: correct all laboratory abnormalities and ipso facto, the patient [… 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]

Dec 012013
 
Do colloids save lives in hypovolemic shock?

So, your patient’s in shock: quick, give some fluids. But colloids or crystalloids? How to choose? They both raise blood pressure, they both improve organ perfusion — but one’s less filling, the other tastes great (what, you haven’t tried them?). It’s no wonder the question makes your head hurt; the evidence base is a jumble. The [… read more]

Oct 292013
 
Esmolol infusion reduced septic shock mortality by 40% in RCT

Do I.V. Beta-Blockers Save Lives in Septic Shock? Catecholamines can be toxic — just ask anyone experiencing the heartbreak of tako-tsubo syndrome. Blocking the heart-flogging effects of the hormones epinephrine (adrenaline) and norepinephrine have long been known to improve long-term survival in congestive heart failure. People with septic shock might be the last group you’d consider giving [… read more]

Sep 132013
 
Mild weight gain after quitting smoking outweighed by cessation's benefits

Weight Gain After Quitting Smoking Usually Mild, Harmless Nicotine is an anorexigen, or appetite suppressant. This “benefit” of cigarette smoking is no secret, certainly not to teenage girls, who in surveys report smoking to stay thin. Even among women smokers over age 40, more than half said they would not quit smoking if it meant they would [… read more]

Aug 162013
 
Vasopressin, steroids, epinephrine cocktail improved cardiac arrest outcomes

Adding Vasopressin, Steroids to Epinephrine Improved Cardiac Arrest Outcomes Contrary to what watching TV or even reading the newspaper will lead one to believe, outcomes after in-hospital cardiac arrest are very poor. Only about 1 in 5 survive to leave the hospital after cardiac arrest, and most survivors suffer significant cognitive impairment; up to half suffer [… read more]

Jul 182013
 
Biomarkers help predict COPD exacerbations

Biomarkers Predict COPD Exacerbations (Sort Of) In addition to daily breathlessness, people with chronic obstructive pulmonary disease (COPD) often experience exacerbations of shortness of breath and coughing. Those with more severe COPD tend to have more frequent and severe exacerbations, lower enjoyment of life, and more rapid loss of lung function. The strongest predictor of [… read more]

Jul 112013
 
Early parenteral nutrition does not improve survival

Early Parenteral Nutrition (TPN) Didn’t Save Lives Under the high stress of critical illness, people lose fat and muscle quickly. Obesity appears to be protective during critical illness, possibly because those extra fat reserves come in handy during this period of accelerated catabolism. The strong physiological rationale and the psychological pressure not to appear to be [… read more]

Jul 102013
 
EUS / EBUS beat transbronchial biopsies for diagnosis of sarcoidosis in RCT

image: Olympus EUS / EBUS Superior at Diagnosing Sarcoidosis This post has been edited from the original to reflect a correction. It originally reported that this trial suggested EBUS alone was superior to transbronchial biopsy; see below. Sarcoidosis affects tens of thousands of people in the U.S., but making the diagnosis can be tricky. A [… read more]

Jul 052013
 
In COPD exacerbations, 5 days steroids seem as good as 14 (REDUCE trial)

For COPD Exacerbations, 5 Days Corticosteroids As Good as 2+ Weeks COPD exacerbations — worsening of shortness of breath and cough, often requiring medical treatment — are a major problem for many people living with COPD. People with moderate or severe emphysema and chronic bronchitis (together called chronic obstructive pulmonary disease) experience an average of [… read more]

Jun 272013
 
Early tracheostomy does not improve survival or other outcomes (TracMan trial)

image: CUHK Early Tracheostomy Does Not Help in Large “TracMan” Trial More than 100,000 tracheostomies are performed worldwide each year for people requiring prolonged periods of mechanical ventilation. It’s generally agreed that to avoid damaging the trachea and throat, a tracheostomy should be placed within 3 weeks of mechanical ventilation. But prior to 3 weeks, [… read more]

May 252013
 
"Checking residuals" during tube feeding on mechanical ventilation: unnecessary?

image: Lighthouse Med. Equip. No Benefit Seen From Monitoring Gastric Volume in Ventilated Patients on Tube Feedings Early enteral nutrition for patients on mechanical ventilation is considered the standard of care. It’s been assumed that delayed gastric emptying, resulting in a stomach full of liquid nutrition, predisposes patients to have aspiration events and develop ventilator [… read more]