PulmCCM http://pulmccm.org/main All the best in pulmonary & critical care Thu, 24 Apr 2014 01:37:52 +0000 en-US hourly 1 http://wordpress.org/?v=3.8.3 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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Early goal directed therapy does not improve outcomes in septic shock (ProCESS) http://pulmccm.org/main/2014/randomized-controlled-trials/early-goal-directed-therapy-improve-outcomes-septic-shock-process-nejm/ http://pulmccm.org/main/2014/randomized-controlled-trials/early-goal-directed-therapy-improve-outcomes-septic-shock-process-nejm/#comments Fri, 21 Mar 2014 13:31:35 +0000 http://pulmccm.org/main/?p=12693 Can we finally “Just Say No” to the mandatory use of central venous catheters and central venous saturation in severe sepsis and septic shock? by Muhammad Adrish, MD In a single center study published in 2001, Rivers et al reported that patients with severe sepsis and septic shock had significantly lower mortality (30.5% vs 46.5%) [... read more]

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Beta blockers safe for most patients with asthma or COPD? http://pulmccm.org/main/2014/asthma-review/beta-blockers-safe-for-most-patients-with-asthma-ajrccm/ http://pulmccm.org/main/2014/asthma-review/beta-blockers-safe-for-most-patients-with-asthma-ajrccm/#comments Sun, 16 Mar 2014 19:43:47 +0000 http://pulmccm.org/main/?p=12653 Beta-Blockers: Safe (and Effective?) for Most Patients with Asthma, COPD Once upon a time in 1964, it was noted that propranolol, a nonselective beta-blocker, could precipitate severe bronchospasm in patients with asthma, especially at high doses. Additional small studies showed propranolol and other nonselective beta blockers could increase airway resistance. British guidelines advise avoiding beta [... read more]

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Bleeding and Coagulation Disorders in the ICU (Review) http://pulmccm.org/main/2014/review-articles/bleeding-and-coagulation-disorders-in-the-icu/ http://pulmccm.org/main/2014/review-articles/bleeding-and-coagulation-disorders-in-the-icu/#comments Sun, 16 Mar 2014 19:36:30 +0000 http://pulmccm.org/main/?p=12635 Because coagulopathies (an impairment of blood clotting), thrombotic states, and bleeding are all interrelated through the coagulation cascade, and because they occur often in critically ill patients, it makes sense to consider these bleeding and clotting disorders together. That’s what Beverly Hunt did in a review in the February 27 2014 New England Journal of [... read more]

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Community Acquired Pneumonia (Review) http://pulmccm.org/main/2014/review-articles/community-acquired-pneumonia-review-nejm/ http://pulmccm.org/main/2014/review-articles/community-acquired-pneumonia-review-nejm/#comments Sat, 08 Mar 2014 13:45:17 +0000 http://pulmccm.org/main/?p=12596 Community-acquired pneumonia (CAP) is “ordinary” pneumonia, usually (but not always) caused by one of a short list of pathogens susceptible to common antibiotics. Pneumonia remains one of the main reasons for hospital admissions, and causes an estimated 3.5 million deaths yearly, including more than 50,000 in the U.S. Catching pneumonia also increases the risk for [... read more]

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Resuscitation Fluids in Critical Illness (Review) http://pulmccm.org/main/2014/review-articles/resuscitation-fluids-in-critical-illness-review-nejm/ http://pulmccm.org/main/2014/review-articles/resuscitation-fluids-in-critical-illness-review-nejm/#comments Sat, 01 Mar 2014 20:11:02 +0000 http://pulmccm.org/main/?p=12578 Resuscitation fluids may be the most common intervention in critical care, with more than 200 million liters of normal saline infused each year in the U.S. alone. However, there is scarce evidence to guide the best use of resuscitation fluids in the ICU. John Myburgh and Michael Mythen’s review article in the September 26 2013 [... read more]

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Bloggers correct the New England Journal on ICU decontamination article http://pulmccm.org/main/2014/critical-care-review/blogger-peer-reviewers-correct-new-england-journal-mrsa-article/ http://pulmccm.org/main/2014/critical-care-review/blogger-peer-reviewers-correct-new-england-journal-mrsa-article/#comments Fri, 28 Feb 2014 17:12:56 +0000 http://pulmccm.org/main/?p=12564 Blogger Peer Review Corrects NEJM Article’s Error In June 2013, PulmCCM unquestioningly reported the results of a major randomized trial in the New England Journal of Medicine by Susan S. Huang et al, showing that decontaminating patients upon arrival to the ICU with chlorhexidine baths and nasal mupirocin resulted in a dramatic drop in nosocomial infections [... read more]

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Critical Care Roundup: Issue #1 http://pulmccm.org/main/2014/critical-care-review/critical-care-roundup-issue-1/ http://pulmccm.org/main/2014/critical-care-review/critical-care-roundup-issue-1/#comments Mon, 24 Feb 2014 02:36:30 +0000 http://pulmccm.org/main/?p=12467 Welcome to issue #1 of the Critical Care Roundup, a new occasional feature on PulmCCM. Here we’ll touch briefly on all the interesting stuff there wasn’t time to thoroughly review. Got a study that should go in the next roundup? Post a link in the comments or by emailing pulmccmcentral@gmail.com. Or, browse all the PulmCCM [... read more]

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Epitaph for nitric oxide for ARDS http://pulmccm.org/main/2014/ards-review/epitaph-nitric-oxide-ards-crit-care-med/ http://pulmccm.org/main/2014/ards-review/epitaph-nitric-oxide-ards-crit-care-med/#comments Sat, 22 Feb 2014 17:17:11 +0000 http://pulmccm.org/main/?p=12464 Image: Dartmouth Nitric Oxide: No Benefit Even in Severe ARDS Giving inhaled nitric oxide to people with acute respiratory distress syndrome (ARDS) improves oxygenation, but has never been demonstrated to improve survival. Not many physicians seem to use nitric oxide for ARDS anymore, except possibly as salvage therapy in life-threatening refractory disease. Even that well-meaning [... read more]

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Sublobar resections as good as lobectomy for stage IA GGO lung cancer? http://pulmccm.org/main/2014/lung-cancer-review/sublobar-resections-as-good-as-lobectomy-for-stage-ia-ggo-lung-cancer/ http://pulmccm.org/main/2014/lung-cancer-review/sublobar-resections-as-good-as-lobectomy-for-stage-ia-ggo-lung-cancer/#comments Thu, 20 Feb 2014 23:23:36 +0000 http://pulmccm.org/main/?p=12402 The new USPSTF lung cancer screening guidelines are about to produce an enormous wave of abnormal chest CTs, with suspicious pulmonary nodules in millions of current and former U.S. smokers. Many will be surgically removed, and thousands of people will be saved from premature death from lung cancer. That’s great news — mostly. Less widely [... read more]

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PulmCCM Journal Launches: Your Submissions Welcome http://pulmccm.org/main/2014/policy-ethics-education-review/pulmccm-journal-launches-your-submissions-welcome/ http://pulmccm.org/main/2014/policy-ethics-education-review/pulmccm-journal-launches-your-submissions-welcome/#comments Mon, 17 Feb 2014 02:11:40 +0000 http://pulmccm.org/main/?p=12522 Dear colleagues, I am excited to announce the launch of PulmCCM Journal, a new online, open access, peer-reviewed journal serving the practicing physician in critical care and respiratory medicine. PulmCCM Journal’s primary mission will be publishing high-quality, highly useful reviews of important clinical topics to improve decision-making and the quality of care worldwide. Case reports, [... read more]

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Delirium in the ICU (Review) http://pulmccm.org/main/2014/review-articles/delirium-icu-review-nejm/ http://pulmccm.org/main/2014/review-articles/delirium-icu-review-nejm/#comments Sun, 16 Feb 2014 22:04:56 +0000 http://pulmccm.org/main/?p=12495 Delirium — sudden, severe confusion that occurs with acute illness — is very common in ICU patients. As a group, patients experiencing delirium in the ICU tend to have worse outcomes than patients without delirium, all other things being equal (as far as that equality can be determined). But no one knows if it is [... read more]

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Tight glycemic control in critically ill kids: benefits, risks still unclear http://pulmccm.org/main/2014/randomized-controlled-trials/tight-glycemic-control-critically-ill-kids-benefits-still-unclear-nejm/ http://pulmccm.org/main/2014/randomized-controlled-trials/tight-glycemic-control-critically-ill-kids-benefits-still-unclear-nejm/#comments Sat, 15 Feb 2014 11:12:58 +0000 http://pulmccm.org/main/?p=12483 Intensive insulin therapy for critically ill adults was rapidly adopted as standard care after 2001 when an apparent benefit was established after cardiac surgery, then medical ICU patients. Eleven years later, after a wave of minor harm signals, the NICE-SUGAR study confirmed for most intensivists that the excess hypoglycemia from intensive glucose control was potentially lethal in adults, and [... read more]

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Vitamin D: no relationship to COPD exacerbations http://pulmccm.org/main/2014/copd-review/vitamin-d-relationship-copd-exacerbations-chest/ http://pulmccm.org/main/2014/copd-review/vitamin-d-relationship-copd-exacerbations-chest/#comments Tue, 11 Feb 2014 23:56:27 +0000 http://pulmccm.org/main/?p=12383 After a stupefying amount of research on vitamin D — with 70 vitamin D studies published in PubMed in January 2014 alone — there is no consistent signal tying vitamin D supplementation to improvement in any health condition. A recent “futility analysis” (a form of meta-analysis) of 40 randomized trials suggests vitamin D does not [... read more]

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Should limited email ads finance PulmCCM’s future? SURVEY RESULTS http://pulmccm.org/main/2014/policy-ethics-education-review/ads-pulmccm-email-finance-future-survey-results/ http://pulmccm.org/main/2014/policy-ethics-education-review/ads-pulmccm-email-finance-future-survey-results/#comments Sun, 09 Feb 2014 20:27:24 +0000 http://pulmccm.org/main/?p=12427 Hello colleagues, PulmCCM has been doing great traffic-wise, but that hasn’t translated into financial health. PulmCCM took a net loss of $1,600 for 2013, including my annual salary of $700 (nope, no omitted zeroes there). That’s OK — making money has never been what this project is about. However, PulmCCM does need continuous funding to [... read more]

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Sedation and Analgesia in the Critically Ill (Review) http://pulmccm.org/main/2014/review-articles/review-sedation-and-delirium-in-the-icu-nejm/ http://pulmccm.org/main/2014/review-articles/review-sedation-and-delirium-in-the-icu-nejm/#comments Sun, 09 Feb 2014 18:13:32 +0000 http://pulmccm.org/main/?p=12409 Pain, agitation, and delirium are all extremely common in ICU patients–so much so that they’ve been termed the “ICU triad.” No one knows exactly how common each is, because ICU patients are often too delirious to complain of pain; or their agitation hides their delirium; or their unidentified pain may cause their agitation; or …. [... read more]

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Can pulmonologists do their own on-site cytopathology during bronchoscopy? http://pulmccm.org/main/2014/interventional-pulmonology/can-pulmonologists-site-cytopathology-bronchoscopy-chest/ http://pulmccm.org/main/2014/interventional-pulmonology/can-pulmonologists-site-cytopathology-bronchoscopy-chest/#comments Tue, 04 Feb 2014 19:20:55 +0000 http://pulmccm.org/main/?p=12378 On-site, intra-procedure cytopathologic examination of aspirated tissue during transbronchial needle aspiration (either by EBUS or “blind” approach) is probably helpful during bronchoscopy. Why wouldn’t it be? You’ve got a trained professional there to tell you when you’ve made the diagnosis and can stop taking biopsies. Diagnostic yield should go up, complications down. Randomized trials have [... read more]

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Spiriva and heart attack risk: new safety kerfuffle http://pulmccm.org/main/2014/randomized-controlled-trials/spiriva-heart-attack-risk-new-safety-kerfuffle-nejm/ http://pulmccm.org/main/2014/randomized-controlled-trials/spiriva-heart-attack-risk-new-safety-kerfuffle-nejm/#comments Sat, 01 Feb 2014 20:52:08 +0000 http://pulmccm.org/main/?p=12367 Last year, PulmCCM reported on the TIOSPIR safety trial comparing the Spiriva dry-powder HandiHaler against the Respimat mist-delivery device. TIOSPIR showed no difference in all-cause mortality or composite cardiovascular risk endpoints between either Spiriva preparation. But this week, a group of drug safety researchers report their granular analysis of TIOSPIR data shows the Respimat device [... read more]

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