Review Articles Archives - Page 2 of 13 - PulmCCM
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Review Articles Articles

Sep 132013
 
Mild weight gain after quitting smoking outweighed by cessation's benefits

Weight Gain After Quitting Smoking Usually Mild, Harmless Nicotine is an anorexigen, or appetite suppressant. This “benefit” of cigarette smoking is no secret, certainly not to teenage girls, who in surveys report smoking to stay thin. Even among women smokers over age 40, more than half said they would not quit smoking if it meant they would [... read more]

Sep 022013
 
Surviving Sepsis Guidelines 2013 - Review & Update

Surviving Sepsis Guidelines 2013 Review & Update The Surviving Sepsis Campaign launched in 2002 as a collaboration between the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, with the shared goal of reducing deaths from sepsis and septic shock around the world. The Surviving Sepsis Campaign periodically publishes its Surviving [... read more]

Sep 022013
 
Surviving Sepsis Guidelines: Diagnosis of Sepsis and Septic Shock

Diagnosis of Severe Sepsis and Septic Shock (from the Surviving Sepsis Guidelines) See all the Surviving Sepsis Guidelines Sepsis is defined as an infection (definite or suspected) with systemic manifestations (any 2 from a list). This definition may seem overly broad — it means that many people with colds and self-limited viral syndromes have sepsis [... read more]

Sep 022013
 
Surviving Sepsis Guidelines: Early Goal Directed Therapy, Initial Fluid Resuscitation

Initial Volume Resuscitation and EGDT for Severe Sepsis/Septic Shock See all the Surviving Sepsis Guidelines An approach including early goal directed therapy with aggressive initial fluid resuscitation has been considered a cornerstone of initial therapy for severe sepsis and septic shock, since a single-center randomized trial showed such a strategy initiated in the emergency department [... 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 162013
 
How to manage lung cancer when resection is high risk

Management of Lung Cancer in High Surgical Risk Patients By Blair Westerly, MD We all hope that surgical resection is an option for our unfortunate patients diagnosed with lung cancer.  However, as a consequence of the epidemiology of stage I non-small cell lung cancer, the standard of care, lobectomy with systematic mediastinal lymph node evaluation, [... 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 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 072013
 
How safe is EBUS? Complication rates <1% at experienced centers

image: Olympus EBUS Complication Rates <1% at Experienced Centers Endobronchial ultrasound (EBUS) — an ultrasound probe on the tip of a bronchoscope — allows real-time viewing of tissues beyond the bronchial wall. It enables more accurate and safer needle biopsies of lymph nodes and masses that abut the bronchial wall. EBUS is an exciting new [... read more]

Jun 022013
 
How to prevent COPD exacerbations

How to Prevent Acute COPD Exacerbations Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major problem for many people living with COPD. Acute exacerbations or attacks occur more often in people with more severe COPD (about 1-2 per year), and these disease flares may either signal or cause a more rapid progression of [... read more]

Apr 242013
 
Using procalcitonin to guide antibiotics for pneumonia

Use of Procalcitonin to Reduce Unnecessary Antibiotics by Blair Westerly, MD Acute respiratory tract infections have a wide range of disease severity and the use of antibiotics for self-limited infections contributes to antibiotic overuse and antimicrobial resistance, though we have all probably been guilty of it a time or two when we just weren’t sure [... read more]

Apr 212013
 
Anti-reflux therapy no help for most with chronic cough

Chronic Cough and Reflux: A Tangled Relationship Although we’re taught that gastroesophageal reflux disease (GERD) is a major cause of chronic cough, the truth may be more complicated, and confusing. A meta-analysis by Peter Kahrilas et al in Chest examining trials of acid-suppressing treatments for chronic cough found no significant benefit of treatment in 7 [... read more]

Mar 312013
 
What works to help people with pulmonary fibrosis feel better? (Review)

Interventions to Improve Symptoms, Quality of Life in Fibrotic ILD: Do They Work? by Brett Ley, MD Patients with fibrotic interstitial lung diseases (e.g. idiopathic pulmonary fibrosis) have a poor overall prognosis, and there are no therapies proven to halt disease progression or extend life. Further, many of these patients have debilitating symptoms, limited functional [... 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]

Feb 212013
 
Intubation in pre-hospital cardiac arrest strongly associated with worse outcomes

Intubation for Out-of-Hospital Cardiac Arrest May Harm, Not Help by Blair Westerly, MD Out of hospital cardiac arrest is a major public-health problem, and despite advances in care, survival is still low. Improved survival has been associated with early CPR, rapid defibrillation, and integrated post cardiac arrest care, but pre-hospital “advanced airway management” (i.e., intubation [... read more]

Feb 122013
 
Pulmonary Hypertension Update, Part 2: Treatment of PH (Review)

Pulmonary Hypertension 2013 Update/Review Part 2 of 2: Treatment of PH by Brett Ley, MD There are 3 classes of pulmonary vasodilator drugs: phosphodiesterase-5 inhibitors (PDE-5 inhibitors, e.g. sildenafil, tadalafil), endothelin receptor antagonists (ERAs, e.g. bosentan, ambrisentan), and prostacyclins (epoprostenol, iloprost, treprostinil).  Because the large trials have focused on PAH, currently only WHO group 1 [... read more]

Feb 052013
 
Pulmonary Hypertension Update, Part 1: Classification & Diagnosis (Review)

Pulmonary Hypertension 2013 Update/Review Part 1 of 2: Classification and Diagnosis by Brett Ley, MD Pulmonary hypertension (PH) is defined simply as a mean pulmonary artery pressure of 25 mmHg or greater. However, this entity encompasses a heterogeneous group of patients and underlying etiologies where accurate diagnosis, correct physiologic classification, and careful evaluation for right heart dysfunction are essential [... read more]

Jan 312013
 
Etomidate associated with increased mortality in sepsis: meta-analysis

Etomidate: Unsafe for Intubation in Patients with Sepsis? by Blair Westerly, MD Etomidate is commonly used for rapid sequence intubation; however, even after one dose, it has been associated with adrenal axis suppression in critically ill patients. Though both adrenal insufficiency and increased mortality in sepsis have been associated with etomidate, the relationship of the [... read more]

Jan 182013
 
Come One, Come All – Low tidal volumes improve outcomes

Low Tidal Volumes Improve Outcomes in Non-ARDS Patients Since the landmark ARDSnet trial of low tidal volume ventilation published in the NEJM in 2000, protecting the injured lung with low tidal volumes has been widely adopted. In case you missed it, that trial showed that low tidal volume ventilation (6 ml/kg IBW) improved mortality from [... read more]