PulmCCM http://pulmccm.org/main All the best in pulmonary & critical care Mon, 21 Jul 2014 12:37:42 +0000 en-US hourly 1 http://wordpress.org/?v=3.9.1 PulmCCM Roundup #5 http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-5/ http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-5/#comments Mon, 21 Jul 2014 01:20:46 +0000 http://pulmccm.org/main/?p=13488 The PulmCCM Roundup gathers all the best in pulmonary and critical care from around the web.  Browse all the PulmCCM Roundups. Statins Fail for COPD, ARDS Statins have been optimistically tested as a tonic for everything from diabetes to dementia — so far, without success. That consistency was maintained in 2 recent trials showing statins’ [... read more]

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Inspiratory collapse of the inferior vena cava: What is it telling us? http://pulmccm.org/main/2014/critical-care-review/inspiratory-collapse-inferior-vena-cava-telling-us/ http://pulmccm.org/main/2014/critical-care-review/inspiratory-collapse-inferior-vena-cava-telling-us/#comments Thu, 17 Jul 2014 15:37:31 +0000 http://pulmccm.org/main/?p=13533 image: EM Ultrasonography Inspiratory collapse of the inferior vena cava: What is it telling us? Jon-Emile S. Kenny M.D. With the dissemination of small, portable, ultrasound devices [or SPUDs], it seems that it is every house-officer’s dream to own the ability and wherewithal to place an ultrasound probe on a patient and find something meaningful; [... read more]

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Prone positioning reduces ARDS mortality by 26%: meta-analysis http://pulmccm.org/main/2014/randomized-controlled-trials/prone-positioning-reduces-ards-mortality-26-meta-analysis/ http://pulmccm.org/main/2014/randomized-controlled-trials/prone-positioning-reduces-ards-mortality-26-meta-analysis/#comments Fri, 11 Jul 2014 16:55:27 +0000 http://pulmccm.org/main/?p=13502 Image: Rotoprone Acute respiratory distress syndrome (ARDS) injures the lungs in a heterogeneous pattern, and the damaged areas are particularly vulnerable to further ventilator-induced lung injury. This is why a lung-protective ventilator strategy using low tidal volumes reduces mortality from ARDS, experts believe. Tidal volumes of 6 mL/kg ideal body weight (calculated from height) using conventional [... read more]

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Using bronchoalveolar lavage to evaluate ILD http://pulmccm.org/main/2014/review-articles/ats-guideline-on-bronchoalveolar-lavage-bal-for-interstitial-lung-disease-ild-ajrccm/ http://pulmccm.org/main/2014/review-articles/ats-guideline-on-bronchoalveolar-lavage-bal-for-interstitial-lung-disease-ild-ajrccm/#comments Tue, 08 Jul 2014 10:43:10 +0000 http://pulmccm.org/main/?p=6490 Using BAL Cellular Analysis in Interstitial Lung Disease The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. BAL findings are usually nonspecific, suggesting rather than proving the existence of any particular noninfectious condition (including interstitial lung disease). That said, in patients with [... read more]

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Azithromycin for COPD exacerbations: 2014 Update http://pulmccm.org/main/2014/review-articles/azithromycin-for-copd-exacerbations-update-review/ http://pulmccm.org/main/2014/review-articles/azithromycin-for-copd-exacerbations-update-review/#comments Fri, 27 Jun 2014 17:30:43 +0000 http://pulmccm.org/main/?p=13475 Azithromycin to Prevent COPD Exacerbations: What’s New? By Abhishek Biswas, MD Multiple previous studies have suggested likely benefits from using azithromycin as an immunomodulator for cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, post-transplant obliterative bronchiolitis and COPD. This month, a new Cochrane analysis and clinical review in JAMA concludes that “continuous macrolide antibiotic use for prophylaxis [is] associated with a [... read more]

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CPAP better than oxygen for obstructive sleep apnea http://pulmccm.org/main/2014/randomized-controlled-trials/cpap-better-oxygen-obstructive-sleep-apnea-nejm/ http://pulmccm.org/main/2014/randomized-controlled-trials/cpap-better-oxygen-obstructive-sleep-apnea-nejm/#comments Thu, 26 Jun 2014 12:57:12 +0000 http://pulmccm.org/main/?p=13462 About half of people diagnosed with obstructive sleep apnea (OSA) can’t or won’t use the most effective therapy, overnight continuous positive airway pressure (CPAP). Most people with untreated OSA experience multiple episodes of hypoxemia — sometimes hundreds per night. For many patients declining CPAP treatment, their doctors provide overnight oxygen, in the hope that it might [... read more]

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PulmCCM Roundup #4 http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-4/ http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-4/#comments Sun, 08 Jun 2014 17:32:58 +0000 http://pulmccm.org/main/?p=13327 All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Asthma Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does seem to improve [... read more]

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Tenecteplase for submassive PE: more conflicting evidence (TOPCOAT) http://pulmccm.org/main/2014/randomized-controlled-trials/tenecteplase-for-submassive-pe-more-conflicting-evidence-topcoat/ http://pulmccm.org/main/2014/randomized-controlled-trials/tenecteplase-for-submassive-pe-more-conflicting-evidence-topcoat/#comments Thu, 05 Jun 2014 15:59:46 +0000 http://pulmccm.org/main/?p=13433 By Parth Rali, MD and Marvin Balaan, MD Submassive pulmonary emboli (PE) are those that are severe enough to produce right ventricular dysfunction on echocardiogram or elevated biomarkers (mainly troponin), but not hemodynamic instability (i.e., systemic blood pressure and cardiac output are preserved). The management of the patient with submassive PE is a matter of controversy with several [... read more]

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N-acetylcysteine: no benefit in idiopathic pulmonary fibrosis http://pulmccm.org/main/2014/randomized-controlled-trials/n-acetylcysteine-benefit-whatsoever-idiopathic-pulmonary-fibrosis/ http://pulmccm.org/main/2014/randomized-controlled-trials/n-acetylcysteine-benefit-whatsoever-idiopathic-pulmonary-fibrosis/#comments Fri, 30 May 2014 15:48:25 +0000 http://pulmccm.org/main/?p=13418 NAC for IPF: Fail (PANTHER-IPF Wrap-Up) Long ago, when pulmonologists were more ingenuous (in 2000), flawed clinical trials convinced the American Thoracic Society to recommend prednisone and either azathioprine or cyclophosphamide in its consensus guideline for some patients with idiopathic pulmonary fibrosis (IPF). By not including a true control arm, the also-flawed follow-up 2005 IFIGENIA trial reinforced this [... read more]

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Nintedanib protects lung function, prevents exacerbations of idiopathic pulmonary fibrosis (INPULSIS) http://pulmccm.org/main/2014/randomized-controlled-trials/nintedanib-protects-lung-function-prevents-exacerbations-of-idiopathic-pulmonary-fibrosis-inpulsis/ http://pulmccm.org/main/2014/randomized-controlled-trials/nintedanib-protects-lung-function-prevents-exacerbations-of-idiopathic-pulmonary-fibrosis-inpulsis/#comments Tue, 27 May 2014 17:39:39 +0000 http://pulmccm.org/main/?p=13406 In 2011 PulmCCM reported the findings of the phase 2 TOMORROW study, showing Boehringer Ingelheim’s tyrosine kinase inhibitor code-named BIBF 1120 reduced lung function decline and prevented exacerbations in people with idiopathic pulmonary fibrosis (IPF). At the 2014 American Thoracic Society annual meeting and in the New England Journal of Medicine, investigators announced their latest [... read more]

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Pirfenidone prolongs survival, preserves lung function in idiopathic pulmonary fibrosis (ASCEND) http://pulmccm.org/main/2014/randomized-controlled-trials/pirfenidone-prolongs-survival-preserves-lung-function-in-ipf-ascend/ http://pulmccm.org/main/2014/randomized-controlled-trials/pirfenidone-prolongs-survival-preserves-lung-function-in-ipf-ascend/#comments Fri, 23 May 2014 20:36:48 +0000 http://pulmccm.org/main/?p=13380 For idiopathic pulmonary fibrosis treatment pirfenidone, the third time wasn’t the charm; the fourth was. After reducing decline in forced vital capacity over one year in a Japanese trial of 275 IPF patients, pirfenidone went one-and-one in the multinational CAPACITY trials (n=779), meeting the primary outcome of FVC preservation in one but not the other. [... read more]

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Medicare bucks USPSTF, denies coverage for lung cancer screening http://pulmccm.org/main/2014/lung-cancer-review/medicare-bucks-uspstf-rations-lung-cancer-screening/ http://pulmccm.org/main/2014/lung-cancer-review/medicare-bucks-uspstf-rations-lung-cancer-screening/#comments Thu, 22 May 2014 20:37:23 +0000 http://pulmccm.org/main/?p=13370 The Centers for Medcare and Medcaid Services sent lung cancer screening’s forward momentum into a tailspin last month, when Medicare’s advisory panel shocked observers by voting  against covering lung cancer screening with annual low dose chest CT as a standard benefit. The U.S. Preventive Services Task Force (USPSTF) had already recommended lung cancer screening be [... read more]

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How to provide nutrition for critically ill patients (Review) http://pulmccm.org/main/2014/review-articles/provide-nutrition-critically-ill-patients-review/ http://pulmccm.org/main/2014/review-articles/provide-nutrition-critically-ill-patients-review/#comments Fri, 16 May 2014 21:12:08 +0000 http://pulmccm.org/?p=11591 Nutritional Support During Critical Illness This PulmCCM topic review will be periodically updated and expanded as new research is published. Originally published 22 September 2013. Most recent update: 16 May 2013. During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism (synthesis of these same macromolecules). Historically, the [... read more]

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Red blood cell transfusions increase hospital-acquired infections (meta-analysis) http://pulmccm.org/main/2014/review-articles/red-blood-cell-transfusions-may-cause-hospital-acquired-infections-meta-analysis/ http://pulmccm.org/main/2014/review-articles/red-blood-cell-transfusions-may-cause-hospital-acquired-infections-meta-analysis/#comments Thu, 08 May 2014 17:39:31 +0000 http://pulmccm.org/main/?p=13331 Red Cell Transfusions Increase Risk for Nosocomial Infection: Meta-Analysis Transfusing blood to anemic patients has an almost irresistible intuitive and theoretical appeal both to physicians and the patients who get transfused. It’s perhaps the archetypal example of the “find it – fix it” approach to doctoring: correct all laboratory abnormalities and ipso facto, the patient [... read more]

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FDA approves implantable tongue-buzzer for obstructive sleep apnea treatment http://pulmccm.org/main/2014/randomized-controlled-trials/fda-approves-implantable-tongue-buzzer-obstructive-sleep-apnea-treatment/ http://pulmccm.org/main/2014/randomized-controlled-trials/fda-approves-implantable-tongue-buzzer-obstructive-sleep-apnea-treatment/#comments Wed, 07 May 2014 13:29:35 +0000 http://pulmccm.org/main/?p=13312 Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device stimulates key airway muscles controlled by the hypoglossal [... read more]

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N-acetylcysteine for COPD: another trial shows benefit (PANTHEON) http://pulmccm.org/main/2014/randomized-controlled-trials/n-acetylcysteine-copd-another-trial-shows-benefit/ http://pulmccm.org/main/2014/randomized-controlled-trials/n-acetylcysteine-copd-another-trial-shows-benefit/#comments Sat, 03 May 2014 12:09:31 +0000 http://pulmccm.org/main/?p=13225 Image: pipingrock.com Can N-acetylcysteine help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? Another randomized trial says yes. N-acetylcysteine, or NAC, is a nutritional supplement with antioxidant and anti-inflammatory properties. After ingestion, N-acetylcysteine is metabolized into glutathione, a key antioxidant with effects throughout the body. In the lungs, glutathione deficiency (common in alcoholics) is linked [... read more]

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Diaphragmatic ultrasound could predict extubation success http://pulmccm.org/main/2014/critical-care-review/diaphragmatic-ultrasound-predict-extubation-success/ http://pulmccm.org/main/2014/critical-care-review/diaphragmatic-ultrasound-predict-extubation-success/#comments Fri, 02 May 2014 23:05:13 +0000 http://pulmccm.org/main/?p=13294 Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate to tidal volume have all been used with varying reported sensitivity [... read more]

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Thrombolytics (tPA) improve intermediate risk PE outcomes, with a few head bleeds (PEITHO Trial) http://pulmccm.org/main/2014/randomized-controlled-trials/thrombolytics-tpa-improves-intermediate-risk-pe-outcomes-with-a-few-head-bleeds/ http://pulmccm.org/main/2014/randomized-controlled-trials/thrombolytics-tpa-improves-intermediate-risk-pe-outcomes-with-a-few-head-bleeds/#comments Fri, 18 Apr 2014 22:43:29 +0000 http://pulmccm.org/main/?p=13216 The use of thrombolytics for pulmonary embolism is not controversial — that is, if the PE is massive with hypotension (give thrombolytics) or mild, with normal blood pressure and right ventricular function (don’t give them). It’s the patients with intermediate risk pulmonary emboli — with normal blood pressure but with evidence of right ventricular dysfunction [... read more]

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Steroids did not improve outcomes in severe COPD exacerbations (RCT) http://pulmccm.org/main/2014/randomized-controlled-trials/steroids-did-not-improve-outcomes-in-severe-copd-exacerbations-rct/ http://pulmccm.org/main/2014/randomized-controlled-trials/steroids-did-not-improve-outcomes-in-severe-copd-exacerbations-rct/#comments Fri, 18 Apr 2014 21:55:47 +0000 http://pulmccm.org/main/?p=13233 Image: 1800petmeds Systemic steroids in COPD exacerbations requiring ventilator support: Are we treating our patients, or ourselves? By Muhammad Adrish, MD Acute exacerbations of COPD are a major cause of hospitalizations, and are associated with more rapid decline in lung function and reduced survival. Because COPD exacerbations are associated with increased inflammatory responses, corticosteroids have [... read more]

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Albumin for severe sepsis and septic shock: More confusing findings (ALBIOS Trial) http://pulmccm.org/main/2014/randomized-controlled-trials/albumin-improve-outcomes-septic-shock-albios-trial/ http://pulmccm.org/main/2014/randomized-controlled-trials/albumin-improve-outcomes-septic-shock-albios-trial/#comments Sun, 13 Apr 2014 14:45:02 +0000 http://pulmccm.org/main/?p=13196 Source: KP Albumin: Better Than Crystalloid in Septic Shock? Human albumin boosts oncotic pressure, and has a number of important biologic functions (protein binding, antioxidant, etc.) that could in theory support the body during critical illness. In the 2004 SAFE study, which tested albumin against crystalloid solutions in ~7,000 critically ill patients of various etiologies, 4% [... read more]

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PulmCCM Roundup #3 http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-3/ http://pulmccm.org/main/2014/randomized-controlled-trials/pulmccm-roundup-3/#comments Fri, 11 Apr 2014 13:59:18 +0000 http://pulmccm.org/main/?p=13173 PulmCCM Roundup #3 All the best in pulmonary and critical care we’ve found lately. Browse all the PulmCCM Roundups. Surviving Sepsis Campaign Responds to ProCESS Trial In the wake of the ProCESS trial demonstrating no benefit from use of protocols for septic shock, the Surviving Sepsis Campaign released a statement in which they “continue to recommend [... read more]

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Catheter directed thrombolysis for submassive PE: better than heparin? (RCT) http://pulmccm.org/main/2014/randomized-controlled-trials/catheter-directed-thrombolysis-submassive-pe-better-heparin-rct/ http://pulmccm.org/main/2014/randomized-controlled-trials/catheter-directed-thrombolysis-submassive-pe-better-heparin-rct/#comments Fri, 04 Apr 2014 15:12:26 +0000 http://pulmccm.org/main/?p=13134 Image: EKOS Patients with acute pulmonary embolism (PE) fall into three general clinical categories: Massive PE, most often defined as hypotension due to right ventricular dysfunction. Short-term mortality is high (more than 1 in 7 die in-hospital). Systemic thrombolytic therapy (tissue plasminogen activator or tPA) is considered standard care by AHA and ACCP, because it [... read more]

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PulmCCM Roundup, Issue #2 http://pulmccm.org/main/2014/review-articles/pulmonary-roundup-issue-1/ http://pulmccm.org/main/2014/review-articles/pulmonary-roundup-issue-1/#comments Thu, 03 Apr 2014 21:06:38 +0000 http://pulmccm.org/main/?p=13080 PulmCCM Roundup #2 Welcome back to the PulmCCM Roundup, formerly the Critical Care Roundup. Let’s jump right in to issue #2. Browse all the PulmCCM Roundups here. Etomidate for intubation in sepsis: what’s the risk, really?  Etomidate has been suspected of causing adrenal insufficiency and potentially death in patients with severe sepsis, when used as an anesthesia-induction agent [... read more]

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FDA warns against doripenem (Doribax) for ventilator-associated pneumonia http://pulmccm.org/main/2014/uncategorized/fda-warns-doripenem-doribax-ventilator-associated-pneumonia/ http://pulmccm.org/main/2014/uncategorized/fda-warns-doripenem-doribax-ventilator-associated-pneumonia/#comments Thu, 03 Apr 2014 20:31:34 +0000 http://pulmccm.org/main/?p=13090 FDA Warning on Doripenem (Doribax) for VAP In March 2014, the FDA issued a warning statement against Doribax (doripenem) for ventilator associated pneumonia, saying: Doribax carries an increased risk of death and lower clinical cure rates compared to use of imipenem and cilastatin … Doribax is not approved to treat any type of pneumonia. (Doripenem is approved [... read more]

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No benefit from higher mean arterial pressure in most with septic shock http://pulmccm.org/main/2014/randomized-controlled-trials/no-benefits-of-higher-mean-arterial-pressure-goals-in-most-with-septic-shock-sepsispam-rct-nejm/ http://pulmccm.org/main/2014/randomized-controlled-trials/no-benefits-of-higher-mean-arterial-pressure-goals-in-most-with-septic-shock-sepsispam-rct-nejm/#comments Sat, 29 Mar 2014 15:09:21 +0000 http://pulmccm.org/main/?p=12730 In Septic Shock, Goal of MAP > 65 mm Hg Remains Standard by Abhishek Biswas, MD In the 13 years since Rivers et al published their seminal paper that established “early goal directed therapy” for sepsis as the standard of care, treatment for severe sepsis and septic shock have evolved dramatically. Newer research questions the wisdom [... read more]

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CCUS Annual Symposium 2014 – only a few spots left to take your ultrasound game to a whole new level! http://pulmccm.org/main/2014/uncategorized/ccus-annual-symposium-2014-spots-left-take-ultrasound-game-whole-new-level/ http://pulmccm.org/main/2014/uncategorized/ccus-annual-symposium-2014-spots-left-take-ultrasound-game-whole-new-level/#comments Tue, 25 Mar 2014 19:12:28 +0000 http://pulmccm.org/main/?p=12715 May 10th and 11th (pre-congress courses on may 9th), Montreal. Great speakers, great topics, great city, great weather (well…hopefully no snow!). Do you know how to use ultrasound to help you diagnose or manage coma, bowel obstruction, CHF, dyspnea, swollen joints and renal failure, among other things?  No matter how good you are at the [... read more]

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