A brief historical and theoretical perspective on patient autonomy and medical decision making: Part II: the autonomy model. Will JF, CHEST 2011;139:1491-1497. ICU Ethics review.
Singh et al’s meta-analysis of 13 randomized trials of pioglitazone or rosiglitazone lasting for at least one year. There were 130 pneumonias among the 8,163 treated patients, and 100 among the 9,464 controls, for a relative risk of 1.40 for the thiazolidinedione group (CI 1.1-1.8, p=0.01). Pioglitazone showed more of a signal with a significant RR of [... read more]
Evans et al attempted a meta-analysis of 9 randomized trials (7 in adults) testing prolonged (4 to 52 weeks) antibiotics in people with bronchiectasis. There was an improvement in “clinical response rate,” a poorly-defined endpoint, in 2 trials, but no difference in exacerbation rates or lung function. Emergence of resistant bacteria was not tested or [... read more]
An attempted meta-analysis of 11 heterogeneous, moderate-quality randomized trials could demonstrate no benefit of incentive spirometry in preventing postoperative pulmonary complications or mortality, in 1,160 patients undergoing upper abdominal surgery, report Guimaraes et al. Cochrane Database Sys Rev 2011;3:CD006058.
Antibiotic dosing in multiple organ dysfunction syndrome: Ulldemolins et al, CHEST 2011;139:1210-1220.
Complete mediastinal lymph node dissection (MLND) is recommended during all surgical reactions of lung cancer — yet “complete” has never been defined, and in a community study, 43% of patients got no MLND. In prospective randomized clinical trial data on 524 patients, Darling et al found that 99% of patients had at least 6 LNs removed, and 90% had 10 [... read more]
Diagnostic value of halo and reversed-halo signs in immune-compromised hosts. Georgiadou SP et al, Clin Infect Dis 2011;52:1144-1155. Review.
End-stage liver disease, critical care management of: Al-Khafaji A et al. Crit Care Med 2011;39:1157-1166. Hepatic failure review.
Lung cancer diagnosis and treatment: summary of updated NICE guidance. Baldwin DR et al, BMJ 2011;342:d2110. Lung cancer review.
Nocturnal monitoring of home non-invasive ventilation: Janssens JP, Thorax 2011;66:438-445. Sleep and obesity hypoventilation review.
Non-CPAP therapies in obstructive sleep apnea, European Respiratory Society task force statement. ERJ 2011;37:1000-1028. Sleep review, OSA review.
CF patients are instructed to inhale dornase alpha 30 minutes before airway clearance techniques. This has always been based on lore and plausibility. Dentice & Elkins publish their meta-analysis of 5 studies, including a total of 122 patients who were randomized and crossed-over to test the effect of the timing of dornase inhalation on outcomes. [... read more]
Pseudomonas pneumonia part II, antibiotic therapy, resistance, pharmacodynamics, Sun H et al, CHEST 2011;139:1172-1185. Review.
Sleep medicine training across the spectrum, Strohl KP, CHEST 2011;139:1221-1231. Sleep review.
Year in Review 2010 in pulmonary & critical care: Heuser et al, Arch Int Med 2011;154:614-621.
Acute liver failure: Larsen FS, Curr Opin Crit Care 2011;17:160-164. Fulminant hepatic failure review.
In a 5-week prospective observational study in 47 Australian & New Zealand ICUs, Pettila et al (the ANZICS group) followed 757 ICU patients receiving red blood cell transfusions for anemia of any cause. Those in the quartile receiving the youngest RBCs (mean age 7.7 days) had an absolute 8% lower mortality than the other 3 [... read more]
Acute-on-chronic liver failure, concept, natural history, prognosis: Olson JC, Curr Opin Crit Care 2011;17:165-169. Hepatic failure review.
Cryptogenic and secondary organizing pneumonia: Drakopanagiotakis F et al, CHEST 2011;139:893-900. COP and BOOP review.
Dabigatran, a new oral thrombin inhibitor : Hankey GJ, Circulation 2011;123:1436-1450.