(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [... read more]
(image: Rex Parker) Among people with unprovoked deep venous thrombosis (DVT) or pulmonary embolism (PE), 1 in 5 will experience another DVT or PE within 2 years after stopping anticoagulation with warfarin (Coumadin). For this reason, the ACCP’s recommendations for treatment of unprovoked proximal DVT or PE suggest consideration of an “indefinite” period of anticoagulation [... read more]
We intensivists are a scarce and valuable commodity — just ask us, we’ll tell you. It’s been consistently shown, for example, that involved intensivists in an ICU during the day correlates with improved mortality and efficiencies in care. Now that’s something we can all cheer (ourselves) about. Many intensivists also like to sleep, and may [... read more]
Colloids are believed to be more effective expanders of plasma volume than crystalloids, making them a tempting therapy to use for patients in septic shock and other causes of hemodynamic instability. Problem is, some colloid solutions seem to kill people. The VISEP Trial using hydroxyethyl starch 200 kDa/0.5 demonstrated that this high molecular weight HES [... read more]
(image: Smokersworld.info) You never see pregnant women smoking in public, but surveys say 12-25% of pregnant women in developed countries smoke during pregnancy. Of course they know they shouldn’t — with smoking’s increased risks for miscarriage, low birth weight, premature birth, birth defects, and even sudden infant death after delivery. Most pregnant women want badly [... read more]
CPAP Improves Metabolic Syndrome in Obstructive Sleep Apnea Continuous positive airway pressure (CPAP) therapy reversed elements of the high cardiovascular risk profile known as metabolic syndrome in a substantial minority of Indians with treatment-naive obstructive sleep apnea, according to this article in the New England Journal of Medicine. More than 75% of people with obstructive [... read more]
Does Enoxaparin Prophylaxis Really Help Most Hospitalized Patients? A huge randomized trial (LIFENOX) stunned experts by showing no benefit of enoxaparin prophylaxis in preventing pulmonary embolism or all-cause mortality in acutely ill medical patients, compared to knee-length graduated compression stockings alone. Ajay Kakkar, Claudio Cimminiello, Jean-Francois Bergmann et al report their surprising results in the [... read more]
Linezolid (Zyvox) for XDR-TB: New Hope, New Caution Approved by the FDA in 2000 for drug-resistant gram positive bacterial infections, linezolid (Zyvox, Pfizer) has in clinical practice been mainly used for skin infections and the occasional pneumonia due to methicillin-resistant Staph aureus (MRSA). Now linezolid looks to be effective as an adjunct therapy for multi-drug resistant [... read more]
(image: Wikipedia) Pleural Mesothelioma Biomarker Fibulin-3: Could It Improve Care? Pleural mesothelioma (malignant mesothelioma) has a dismally sad prognosis of about a year after diagnosis. Earlier detection of this lethal pleural cancer could conceivably result in earlier treatment and some improvement in life expectancy. Researchers report in the October 11, 2012 New England Journal of [... read more]
Supraventricular Tachycardia, Initial Diagnosis and Treatment When supraventricular tachycardia (SVT) causes symptoms, it requires immediate medical attention. Although many physicians believe that the precise type of SVT must be identified before providing treatment, this is not true: treatment can often be started safely and effectively without knowing the exact SVT, by tailoring it to the [... read more]
New Lung Tissue Growth Discovered: Is Some Lung Regeneration Possible? Lung regeneration has never been thought possible in adults. But Steven Mentzer et al from Brigham and Women’s at Harvard reported a case of a 33 year old woman who had an apparent 64% increase in the number of functioning alveoli in her left lung, during [... read more]
Preventing Hospital Acquired Infections: Stopping Payment Had No Effect In October 2008, the U.S. Centers for Medicare and Medicaid Services (CMS) stopped paying for two hospital-acquired infections: urinary infections due to indwelling catheters (UTIs) and central catheter-associated bloodstream infections (CABSI). At the time the policy was announced years ago, it was described as an incentive [... read more]
(image: DiagnosticClinic.com) Exacerbations of chronic obstructive pulmonary disease (COPD exacerbations) occur with wide variability in people with COPD, and no one really knows why. Respiratory infections, interactions with coexistent cardiovascular disease, and pulmonary embolism have all been implicated as causes of exacerbations. But some people with COPD experience exacerbations that are mild and infrequent, while [... read more]
Hypertonic Saline & Mannitol for Raised Intracranial Pressure (More PulmCCM Topic Updates) Acute brain injuries of all sorts increase the pressure inside the skull (intracranial pressure). Traumatic brain injury, bleeding in or around the brain, severe ischemic stroke, and acute hepatic failure all raise intracranial pressure, and increased intracranial pressure often becomes the most severe [... read more]
Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers? As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide [... read more]
Management of Opioid Overdose in the ICU: Review (More PulmCCM Topic Updates) Thanks to a 700% increase in the number of opioid prescriptions for pain management, combined with a perhaps greater rise in the rate of prescription opioid abuse, the number of serious opioid overdoses in the US has climbed dramatically over the past decade. [... read more]
Immunotherapy — creating antibodies to tumor markers, then activating the immune system to selectively kill cancer cells — is the newest and most-hyped frontier of oncology. And with some justification: the mechanism is cleaner and kinder than chemotherapy, and being a whole new treatment modality, can complement and augment traditional therapies. Results of immunotherapy in [... read more]
For a great video example of dynamic extra-thoracic airway obstruction, click the below link to the July 5, 2012 New England Journal of Medicine. This 53-year-old woman had a traumatic laryngeal fracture as a child, and presented with daytime somnolence and inspiratory stridor. On laryngoscopy, she had proliferation of the mucosa over the vocal cords, [... read more]
This gentleman (not pictured in the photo) graciously allowed himself to be videotaped in the midst of a severe whooping cough episode caused by Bordetella pertussis; the video is posted on the New England Journal’s website. He had not been vaccinated: vaccination during childhood greatly reduces the risk of severe or life-threatening pertussis infection, and reduces [... read more]
Drowning: 2012 Review (More PulmCCM Topic Updates) There are a thousand ways to die (it’s even a TV show), but few seem as horrible and inspire such primal fear as death by drowning. Drowning is uncommon but by no means rare in the U.S.: it’s the second leading cause of death by injury in the [... read more]