Review Articles Archives - Page 5 of 13 - PulmCCM
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Apr 212012
 
Pneumothorax in the ICU (Review, Chest)

From the excellent review by Lonny Yarmus and David Feller-Kopman in the April 2012 Chest, along with the British Thoracic Society and ACCP’s consensus statements: Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the [... read more]

Apr 142012
 
NYU's Clinical Correlations: a great internal medicine review

We have our hands full at PulmCCM Central just keeping up with the best published literature in pulmonary and critical care medicine. Somehow, the folks at NYU manage to vet the much larger volume of literature published in internal medicine, and offer it in a user-friendly review in their Clinical Correlations blog. Clinical Correlations is [... read more]

Mar 152012
 

Diaphragmatic dysfunction can result from nerve damage, primary muscle problems, or problems with the muscle’s interaction with the chest wall. The true incidence of diaphragmatic paralysis is unknown, since many patients are asymptomatic. Treatment for diaphragmatic dysfunction usually consists of watchful waiting, addressing underlying causes, with mechanical ventilation if respiratory failure develops. Causes of Diaphragmatic [... read more]

Mar 022012
 
Walk to wean: Early mobilization for ventilated patients (Review, CHEST)

Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress and William Schweickert have turned their attention to early mobilization as the next intervention that could help mechanically ventilated patients escape the ventilator faster. [... read more]

Feb 062012
 

Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [... read more]

Feb 052012
 
Systemic steroids for severe sepsis and septic shock (Review)

The benefits of corticosteroids as a treatment for severe sepsis and septic shock (if any) are unknown: Although adrenal suppression is common in sepsis, it is still unclear how to assess adrenal function, or whether it should be done at all. The sensitivity and specificity of the cosyntropin (ACTH) stimulation test are unknown, and its [... read more]

Jan 272012
 

C. difficile has always been a foul and disgusting adversary, but lately it’s becoming more formidable and deadly, according to Linda Bobo, Erik Dubberke and Marin Kollef. A few highlights of this excellent review: C.diff infections (CDI) have more than doubled since 2001, to > 340,000 discharges in 2008. Attributable mortality is 6-7%, but may [... read more]

Jan 212012
 
Omitting heparin prophylaxis in first 24 ICU hours associated with higher mortality (CHEST)

As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [... read more]

Jan 082012
 
Early tracheostomy doesn't improve outcomes ... much (Meta-analysis, CHEST)

[poll id="3"] A 2005 meta-analysis of 5 studies (n=406) concluded that early tracheostomy reduced need for mechanical ventilation and ICU days. But then a 2006 randomized trial in trauma patients found no benefit to early trach, and an underpowered 2008 RCT also found no benefit. In a new meta-analysis and systematic review of 7 trials (n=1,044), Fei [... read more]

Jan 082012
 
Elderly critically ill who survive ICU rationing live well (CHEST)

Many argue that as a limited resource serving unlimited needs, medical care is “rationed” by definition, and ICU resources (being more limited and expensive) are simply more overtly rationed. For example, in France, ICU admission is often denied to the very elderly critically ill, explicitly because of their age (this happens in the U.K., too, probably). In the U.S., [... read more]

Jan 012012
 
ACP advises against universal DVT/PE prophylaxis! "Quality" quagmire thickens (Guideline/Review, Ann Intern Med)

Daunted by the seeming impossibility of measuring and comparing hospitals on real outcomes (given our primitive state of data collection and heterogeneity in patient populations, among many other challenges), well-meaning bureaucrats and non-profiteering safety advocates like the Institute for Healthcare Improvement have created directives based on surrogate measures in an attempt to standardize and improve [... read more]

Jan 012012
 

This nice (and brief) review article on interpreting elevated troponin levels can be summed up by its quote from cardiologist Robert Jesse: “When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.” Troponin abnormality is set at the 99th [... read more]

Jan 012012
 

Air Travel for Patients with Lung Disease (BTS Recommendations) Some interesting facts, figures, and recommendations on air travel for those with chronic lung disease, thanks to Ahmedzai et al who produced this 32 page document for the British Thoracic Society: At 8,000 feet in a commercial aircraft, you’re breathing 15% O2, and normal people’s SpO2 [... read more]

Jan 012012
 

After receiving hundreds of postmarketing adverse event reports of suicidal thoughts or behaviors (and 32 completed suicides) associated with smoking cessation drug varenicline (Chantix), the FDA slapped a black box warning on the med in 2009 and commissioned two large retrospective observational studies totaling more than 40,000 patients starting either varenicline (Chantix) or nicotine replacement. [... read more]

Jan 012012
 

Severe sepsis makes the heart irritable, probably due to all the evil humors and increased cardiac demand. Between 6-20% of patients with severe sepsis develop atrial fibrillation for the first time; that’s old news. What’s been unclear is what new-onset atrial fibrillation in severe sepsis means: is it an expected, yeah-so-what marker of critical illness, [... read more]