Review Articles Archives - PulmCCM
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Aug 012015
 

ICU Physiology in 1000 Words Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) Jon-Emile S. Kenny M.D. [@heart_lung] Perhaps the most memorable patient of both my pulmonary and critical care fellowships was that of a very young woman who suffered from propofol-related infusion syndrome [PRIS]. As a consequence of PRIS, she endured multiple cardiac arrests and was placed [… read more]

May 172015
 
The only VAP prevention method that saves lives is the one you’re not using

There’s always been doubt about the efficacy of the numerous “ventilator bundles” hospitals use to prevent ventilator-associated pneumonia (VAP). A provocative new analysis concludes that none of these methods save lives — except the one that almost no ICUs are using today. Healthcare associated pneumonias (HAP), especially ventilator-associated pneumonias (VAP), are associated with increased mortality, excess antibiotic use, lengthened hospital [… read more]

May 062015
 
Is more than one patient per ICU nurse dangerous?

The fewer patients an ICU nurse has to juggle, the better those patients’ chances of making it out of the hospital alive, according to a large observational study published in Critical Care Medicine. Data from the large EPIC II study suggested that two patients per nurse may be too many for safe, high-quality critical care. Nurse-to-patient [… read more]

Mar 282015
 
Surviving Sepsis Says EGDT Not Needed in All Patients with Septic Shock

As regular PulmCCM readers know, the ProCESS, ARISE and ProMISe randomized trials showed no benefit of protocolized early goal-directed therapy as compared to usual conscientious care in the treatment of severe sepsis and septic shock. In response to ProCESS and ARISE, the influential Surviving Sepsis Campaign now advises that measurement of central venous pressure (CVP) and [… read more]

Mar 192015
 
ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 2 of 2)

ICU Physiology in 1000 Words The Right Ventricular Afterload [Part 2 of 2] Jon-Emile S. Kenny M.D. [@heart_lung] Having considered the short-comings of Laplace’s Law and the PVR with respect to the RV afterload in part 1, we will now turn to each of the following in turn: the pulmonary arterial input impedance, a measureable [… read more]

Mar 152015
 
How safe is thoracentesis? Giant case series sheds light

Thoracentesis for pleural effusion — that is, inserting a long needle between someone’s ribs to drain a fluid collection from the chest — has always come with a scary menu of potential risks, including pneumothorax, hemothorax and pulmonary edema. A new study reports a low complication rate from thousands of thoracenteses. But debate will remain whether the safety results — achieved [… read more]

Mar 132015
 
ICU Physiology in 1,000 Words: Right Ventricular Afterload (Part 1 of 2)

ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 1 of 2) By Jon-Emile S. Kenny M.D. With my trusted-resident – Dr. Lina Miyakawa – at my side we watched as our patient could not maintain his oxygen saturation above 82%. The patient had terrible aspiration pneumonia superimposed upon horrendous methamphetamine-related pulmonary arterial hypertension [… read more]

Mar 052015
 
E-cigarettes double smokers' quit rates vs placebo: meta-analysis

Electronic cigarettes containing nicotine can double smokers’ rates of quitting at one year, compared to e-cigarettes without nicotine (placebo), according to a new small meta-analysis published in the Cochrane Database of Systematic Reviews. The rates of smoking cessation using nicotine-containing e-cigarettes (9%) were roughly comparable to that seen with other forms of nicotine replacement therapy in past trials. The [… read more]

Feb 132015
 
The PulmCCM App Re-Re-Launches, Again

Longtime readers of PulmCCM will remember, there once was an app for iPhone and Android phones. Then, one day, there wasn’t. Technical difficulties, etc. Then, just when everyone had almost forgotten about it, the app was back! Most people had moved on with their lives, but a few were touched by this digital comeback story. Then — [… read more]

Feb 062015
 
E-cigarettes fuss over formaldehyde: don't believe the hype (yet)

Electronic cigarettes (e-cigarettes) work via a heating element that the user activates while inhaling. Nicotine, along with a liquid solvent (usually propylene glycol), flavorings and whatever else is in the solution are vaporized (aerosolized, really) at the high temperature and inhaled by the user. E-cigarette sales are now a $1.5 billion/year business, growing by an [… read more]

Feb 012015
 
PulmCCM Journal Vol. 1, Issue 2 Now Available

On behalf of the PulmCCM Journal editorial board, it is with great pleasure that I announce the publication of the second issue of PulmCCM Journal, an open-access, peer-reviewed journal in pulmonary and critical care medicine. You can read the new issue online at pulmccm.org/journal, or click “Journal” in the menu bar above. PulmCCM Journal’s mission is to [… read more]

Feb 012015
 
ICU Physiology in 1,000 Words: Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation by Jon-Emile S. Kenny, MD The first time I performed cardiopulmonary resuscitation [CPR] on a patient was in the emergency department of Sunnybrook Hospital in Toronto, Canada; it was certainly an indelible moment in my training. As an intern, and especially as medical consult at Bellevue Hospital in New York City, I was [… read more]

Jan 052015
 

Here are some of the biggest stories and most important published research findings in critical care and respiratory medicine for 2014. Enjoy, and subscribe to the PulmCCM weekly email newsletter to stay up to date in pulmonary and critical care. Early goal directed therapy does not improve outcomes in septic shock (ProCESS) Are traditional protocols [… read more]

Dec 052014
 

In Defense of the Central Venous Pressure Jon-Emile S. Kenny M.D. In the waning days of my fellowship I received a hemoptysis consult in the cardiac care unit. Sifting through CT scans, I overheard two house-officers giving sign-out for the evening. When reviewing the clinical data, one of the residents referred to the central venous pressure [… read more]

Oct 312014
 
Life after sepsis protocols: What now? (You decide.)

2014 has been a rough year for advocates of sepsis protocols. First, the long-awaited ProCESS trial did not show any benefit from use of the original early goal-directed therapy (EGDT) protocol used in the single-center 2001 trial by Rivers et al that, despite criticism, became the standard of care for the following decade. Patients cared for in the 2 non-EGDT arms [… read more]

Oct 162014
 
ICU Physiology in 1,000 Words: Stroke Volume Variation and the Concept of Dose-Response

Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [… 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]

Sep 052014
 
New 2014 Pulmonary Hypertension guidelines released

The American College of Chest Physicians (unaffiliated with PulmCCM) published its new consensus guidelines in August 2014 for the drug treatment of pulmonary arterial hypertension (PAH). They’re free to view on the Chest website, and well worth a look. Remember that pulmonary arterial hypertension (PAH) is but one small subset (“Group 1”) of the much larger [… read more]

Aug 162014
 
Which cancer patients need prophylaxis for DVT and pulmonary embolism?

People with cancer have the highest rates of deep venous thrombosis (DVT) and pulmonary embolism (PE). However, the risk of venous thromboembolism varies widely by cancer type and between patients. Daily anticoagulant use can reduce the risk of DVT and pulmonary embolism, but at a cost of increased bleeding risk, patient inconvenience and discomfort, and cost. [… read more]