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Aug 032013
 
Riociguat for Pulmonary Hypertension: New Kid on the Block

New Pulmonary Hypertension Drug Riociguat Proves Effective Pulmonary arterial hypertension is a rare but life-threatening illness affecting around 10,000 people in the U.S., in which ongoing remodeling of the pulmonary vasculature leads to narrowed pulmonary arteries with increased pulmonary artery pressure (pulmonary hypertension), and if untreated, eventual right heart failure and death. (The overwhelming majority [... read more]

Aug 032013
 
Riociguat improves chronic thromboembolic pulmonary hypertension (CTEPH)

Riociguat Improves Chronic Thromboembolic Pulmonary Hypertension (CTEPH): CHEST-1 Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of pulmonary embolism, in which the pulmonary blood vessels become occluded by the body’s ongoing reaction to residual blood clots. The result is slowly worsening shortness of breath, pulmonary hypertension, and eventually right heart failure. People with chronic [... read more]

Jul 272013
 
How to ration lung cancer screening CTs, rationally

Restrict Lung Cancer Screening CT To Highest-Risk People? The National Lung Screening Trial showed that 3 annual low-dose chest CT scans in people with heavy smoking histories (30+ pack-years) saved lives, reducing the risk of death from lung cancer by a relative 20% compared to screening with annual chest X-rays. With 160,000 lung cancer deaths [... read more]

Jul 272013
 
Diagnosing and managing obstructive sleep apnea, before and after surgery (Review)

Obstructive Sleep Apnea and Perioperative Complications: A Review Obstructive sleep apnea and other sleep disorders may affect as many as 70 million U.S. adults — 1 in 4 men and 1 in 10 women. People with obstructive sleep apnea are usually obese, have other medical conditions, and are more likely to undergo surgery than people [... read more]

Jul 192013
 
Intensivists overnight in the ICU don't help, if you're already good

Nighttime Intensivist Staffing Does Not Help (Again) As I’ve said before, probably past the point of being annoying, we intensivists perform a vital service for humanity — just ask us. Numerous studies have concluded that a specialized intensivist’s presence in an intensive care unit during the day saves lives and results in better use of health [... read more]

Jun 212013
 
In intracerebral hemorrhage, rapid blood pressure reductions were safe (INTERACT2)

image: Wikipedia Rapid Blood Pressure Control Doesn’t Hurt, May Help in Intracerebral Hemorrhage Strokes caused by intracerebral hemorrhage — sudden bleeding into the brain — are as devastating as they sound. Almost half of people with intracerebral hemorrhage (ICH) die within a month, and most of the survivors end up in nursing homes or needing [... read more]

Jun 212013
 
High-Altitude Illness: Prediction, Prevention, Treatment

Getting Sick at High Altitude: Prevention & Treatment Rapidly ascending above altitudes of 8,200 feet (2,500 meters) from lower elevations can result in illness ranging from mild nausea and headaches, to life-threatening edema of the lungs or brain. Truth is, there is little data to help physicians prevent or treat high-altitude illnesses, or to counsel [... read more]

Jun 162013
 
Decontaminate all incoming ICU patients to reduce infections, says RCT

“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [... read more]

Jun 072013
 
Managing anticoagulation for surgery and invasive procedures (Review)

Managing Anticoagulation Therapy For Surgery and Procedures (NEJM) See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: This is a summary of an article in a medical journal, provided as a service to physicians. It is not medical advice. No one should ever make changes to their anticoagulation treatment except under a physician’s supervision. [... read more]

Jun 022013
 
A turn for the best? Prone positioning saves lives in ARDS trial

Prone Positioning Saves Lives in Severe ARDS Patients: NEJM It’s long been known that positioning patients with ARDS on mechanical ventilation face-down (prone) improves their oxygenation. (There are various theories why prone positioning helps, such as by reducing ARDS’s injurious heterogeneous alveolar overdistension.) The improved oxygen levels have never translated into improved outcomes in ARDS [... read more]

May 232013
 
New lung cancer prediction tool promises better use of screening CT

New Prediction Model Selects Best Lung Cancer Screening Candidates In the National Lung Screening Trial (NLST), screening for lung cancer with low-dose chest CT scans resulted in a 20% reduction in death from lung cancer. The consumer-serving American Lung Association recommended outright that older people with heavy smoking histories should get lung cancer screening; leading [... read more]

May 182013
 
Taking Apixaban (Eliquis) after completing Coumadin prevents recurrent DVT/PE

Apixaban (Eliquis) Prevents Recurrent DVT-PE Long-Term People with unprovoked venous thromboembolic disease (pulmonary embolism or deep venous thrombosis, or DVT) are at high risk for recurrence, and current ACCP guidelines advise consideration of “indefinite” anticoagulation. Warfarin (Coumadin) is a wonder drug efficacy-wise, reducing the risk of pulmonary embolism and deep venous thrombosis by ~90%. However, [... read more]

May 122013
 
Allowing families to witness CPR had positive effects (RCT)

Families Allowed to Witness CPR Felt Better, Had Fewer Regrets Should family members be allowed, or even encouraged, to witness the health care team’s attempts to revive their family member with CPR after a cardiac arrest? In the interests of openness and transparency, many have argued “yes,” with the thought that witnessing the heroic efforts [... read more]

Mar 162013
 
High frequency oscillation ventilation fails as 1st-line treatment for ARDS (RCTs)

(image: Wikipedia) High-Frequency Oscillatory Ventilation (HFOV) for ARDS Two Randomized Trials: Early HFOV Doesn’t Help, May Harm High-frequency oscillatory ventilation (HFOV) has been proposed as a first-line therapy for acute respiratory distress syndrome (ARDS). By delivering 3-15 breaths per second of tiny tidal volumes (~70 mL), HFOV has appeal as the “ultimate” lung protective ventilator [... read more]

Mar 132013
 
Weaning from Mechanical Ventilation Update (Review)

Weaning From Mechanical Ventilation Update (See More PulmCCM Reviews) by Brett Ley, MD Nearly 800,000 patients require mechanical ventilation yearly. There’s no doubt it is a life-saving intervention, but it is one that is fraught with the potential for iatrogenesis, especially if continued for longer than necessary. That is the main message of this review in [... read more]

Mar 102013
 
Hope floats: Fecal transplants cure >90% of recurrent C. difficile (RCT)

Fecal Transplants Cure C. difficile Infections, When Drugs Can’t Antibiotics are what cause Clostridium difficile infection to emerge in the first place, so it’s perhaps no surprise that the usual treatment — more antibiotics — often fails. From 15-25% of patients with C. difficile are not permanently cured by their initial treatment with metronidazole, and among those [... read more]

Mar 062013
 
Diuretics beat ultrafiltration at treating congestive heart failure with acute renal failure (RCT)

Ultrafiltration No Better Than Diuresis for CHF Exacerbations by Blair Westerly, MD Cardiorenal syndrome — simultaneous heart failure and renal failure — is a frequently encountered problem in people with acute decompensated heart failure.  Treatment with diuretics for congestive heart failure exacerbations is standard care, but diuretics may at times worsen renal function. Venovenous ultrafiltration [... read more]

Feb 072013
 
Blood transfusion harmful, even deadly, in some patients with GI bleeds (RCT)

Blood Transfusion: Deadly for GI Bleeds? You read the headline right: in a randomized trial published in the January 3 New England Journal of Medicine, liberal blood transfusions (to a hemoglobin of 9 g/dL) seemed to cause the deaths of people with acute upper gastrointestinal bleeding, as compared to transfusing when hemoglobin fell below 7 [... read more]

Jan 062013
 
PANTHER-IPF negative, stopped early for harm from steroids, Imuran in IPF (RCT)

(image: Wikipedia) As we reported a few months ago, the PANTHER-IPF trial was stopped early for safety, when it became clear that the combination of prednisone and azathioprine was hurting people with idiopathic pulmonary fibrosis (IPF). Ganesh Raghu (U-Washington), Kevin Anstrom (Duke), Talmadge King (UCSF) et al report the final results in the May 24 New [... read more]