New England Archives - Page 2 of 8 - PulmCCM
Advertisement


New England Articles

Feb 282014
 
Bloggers correct the New England Journal on ICU decontamination article

Blogger Peer Review Corrects NEJM Article’s Error In June 2013, PulmCCM unquestioningly reported the results of a major randomized trial in the New England Journal of Medicine by Susan S. Huang et al, showing that decontaminating patients upon arrival to the ICU with chlorhexidine baths and nasal mupirocin resulted in a dramatic drop in nosocomial infections [... read more]

Feb 152014
 
Tight glycemic control in critically ill kids: benefits, risks still unclear

Intensive insulin therapy for critically ill adults was rapidly adopted as standard care after 2001 when an apparent benefit was established after cardiac surgery, then medical ICU patients. Eleven years later, after a wave of minor harm signals, the NICE-SUGAR study confirmed for most intensivists that the excess hypoglycemia from intensive glucose control was potentially lethal in adults, and [... read more]

Feb 092014
 
Sedation and Analgesia in the Critically Ill (Review)

Pain, agitation, and delirium are all extremely common in ICU patients–so much so that they’ve been termed the “ICU triad.” No one knows exactly how common each is, because ICU patients are often too delirious to complain of pain; or their agitation hides their delirium; or their unidentified pain may cause their agitation; or …. [... read more]

Feb 012014
 
Spiriva and heart attack risk: new safety kerfuffle

Last year, PulmCCM reported on the TIOSPIR safety trial comparing the Spiriva dry-powder HandiHaler against the Respimat mist-delivery device. TIOSPIR showed no difference in all-cause mortality or composite cardiovascular risk endpoints between either Spiriva preparation. But this week, a group of drug safety researchers report their granular analysis of TIOSPIR data shows the Respimat device [... read more]

Jan 182014
 
Implantable tongue-buzzer improves obstructive sleep apnea by 70%

Source: Inspire Med Systems Update: Inspire’s hypoglossal nerve stimulator was approved by the FDA in April 2014. Hypoglossal Nerve Stimulation Markedly Improves OSA An estimated 15% of men and 6% of women in the U.S. have clinically significant obstructive sleep apnea, meaning it worsens their daytime cognitive functioning, cardiovascular risk, or both. In obstructive sleep [... read more]

Jan 122014
 
Cognitive impairment after critical illness as bad as Alzheimer's

People who survive critical illness often experience long-term cognitive impairment, even among those with normal or near-normal pre-hospital brain function. Cognitive impairment after critical illness is poorly understood; relatively few prospective clinical trials in critical care have followed patients after hospital discharge, and measuring cognitive impairment and determining its onset is difficult. Cognitive impairment reduces [... read more]

Jan 052014
 
Acute Liver Failure: Causes & Initial Management (Part 1 of 2)

Acute Liver Failure: Causes and Initial Management See also: Treatment of Acute Liver Failure Acute liver failure, also called fulminant liver failure, has been defined as “a severe liver injury, potentially reversible in nature and with onset of hepatic encephalopathy within 8 weeks of the first symptoms in the absence of pre-existing liver disease.” Acute [... read more]

Jan 052014
 
Acute Liver Failure: Treatment (Part 2 of 2)

Acute Liver Failure: Treatment (Part 2 of 2) See also: Acute Liver Failure: Causes & Initial Management Management of acute liver failure is largely supportive critical care for the multiorgan failure that frequently results. Severe acute liver failure results in rapidly progressive hepatic encephalopathy and lethal cerebral edema; this complication requires special vigilance and expert [... read more]

Dec 082013
 
Ventilator-Induced Lung Injury Review (Part 2 of 2)

Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [... read more]

Dec 072013
 
Ventilator-Induced Lung Injury Review (Part 1 of 2)

Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, especially when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation can damage fragile alveoli already made vulnerable [... read more]

Nov 232013
 
Hypothermia did not help after out-of-hospital cardiac arrest, in largest study yet

No Improvement in Cardiac Arrest Outcomes With Hypothermia Therapeutic hypothermia, or targeted temperature management, has become a standard component of post-cardiac arrest care. The evidence supporting this practice came from two small-to-medium-sized randomized trials, both published in the New England Journal of Medicine in 2002: Among 273 patients with out-of-hospital cardiac arrest due to shockable [... read more]

Nov 162013
 
Shock Review: Mechanisms and Therapies

Shock Review (Part 1 of 2) (See also Shock Review Part 2: Goals of Therapy) Jean-Louis Vincent, editor in chief of Critical Care, has a new review article on circulatory shock in the New England Journal of Medicine, where he’s also the editor of their new critical care section. Daniel De Backer co-authors. (See also [... read more]

Nov 162013
 
Shock Review: Goals of Therapy

Shock Review (Part 2 of 2) (See also Shock Review Part 1: Mechanisms and Therapies) Shock results from serious illness compromising either vascular muscle tone (most commonly septic shock), the heart’s function, or the volume of plasma inside blood vessels. The true goal of treatment for shock is to correct the underlying cause, but except [... read more]

Nov 082013
 
"CPAP cures metabolic syndrome" paper in NEJM: retracted!

In early 2012, PulmCCM breathlessly reported the results of a New England Journal of Medicine (NEJM) paper by Surenda K. Sharma et al, claiming to show that continuous positive airway pressure (CPAP) can reverse metabolic syndrome (obesity, dyslipidemia, and insulin resistance). Whoops. The authors retracted the article after keen-eyed academics smelled something fishy and asked [... read more]

Oct 232013
 
Dupilumab reduced asthma exacerbations by ~90% in RCT

Dupilumab, an injectable monoclonal antibody that inhibits signaling by interleukin-4 and interleukin-13, reduced asthma exacerbations by almost 90% while also improving asthma symptoms in a randomized trial. Participants had moderate-to-severe asthma that had previously been uncontrolled despite use of inhaled corticosteroids with long-acting beta-agonists. Twenty five million people in the U.S. — 8% of the population [... read more]

Oct 162013
 
Spiriva Respimat inhaler as safe as HandiHaler (TIOSPIR)

Tiotropium: Safe In Either Form Tiotropium (Spiriva) comes in two devices: the Respimat in Europe delivers a mist, while the Handihaler in the U.S. delivers a dry powder. The Respimat has been bronchodilating under a dark cloud in Europe for the past 2 years, since a BMJ meta-analysis suggested there was a 52% increased risk of [... read more]

Aug 242013
 
How to diagnose asthma (Review)

Diagnosis of Asthma: Review & Update Asthma is a poorly understood disease characterized by chronic inflammation of the airways (bronchi and bronchioles). This inflammation causes periodic constriction of the airways in people with asthma, with shortness of breath, wheezing, and coughing that is often worse at night or early in the morning. Asthma is thought [... read more]

Aug 242013
 
More children to be considered for adult lung transplants

More Children Under 12 to Be Considered for Adult Lung Transplants The Organ Procurement and Transplantation Network (OPTN), which is responsible for the life-and-death policies for allocation of lung transplants and other organs, announced it will allow children needing lung transplants to file expedited appeals to be listed for adult lungs. Children under 12 with [... read more]

Aug 112013
 
Low tidal volume ventilation reduces complications from abdominal surgery

Low Tidal Volume Ventilation Improves Outcomes in Elective Surgery Using low tidal volumes (6-8 mL/kg ideal body weight, or about 500 mL in the average man) during mechanical ventilation has been known for more than a decade to be lifesaving for people with acute respiratory distress syndrome (ARDS). Since reducing mortality by a relative 22% [... read more]