JAMA Archives - PulmCCM
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JAMA Articles

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]

May 202013
 
Staph vaccine fails in cardiothoracic surgery patients

Staph Vaccine Fails in Cardiothoracic Surgery Patients Staphyloccocus aureus wound infections and bacteremia commonly complicate cardiothoracic surgery, even with meticulous attention to infection prevention. Staph mediastinitis, a deep infection of the surgical wound, is particularly feared and lethal. Vance Fowler et al randomized 8,031 people undergoing sternotomy to receive the V710 vaccine against S. aureus, [... read more]

May 122013
 
Killer carbapenem-resistant bacteria spreading through LTACs

Killer Carbapenem-Resistant Bacteria Spreading Across U.S. Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S. Carbapenems  like meropenem and doripenem have been the gold standard to treat infections from [... read more]

Apr 242013
 
Using procalcitonin to guide antibiotics for pneumonia

Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [... read more]

Apr 122013
 
Inferior vena cava filters: debatable benefit; rarely removed

image: Wikimedia Inferior Vena Cava Filters: What’s the Harm? Do inferior vena cava filters actually create more harm than health? That’s the provocative question being posed by authors and editorialists in JAMA Internal Medicine. Inferior vena cava filters are frequently placed after a pulmonary embolism (PE) or deep venous thrombosis (DVT) in patients with a [... read more]