Sep 192017
 
FDA approves first three-in-one inhaler for COPD

GlaxoSmithKline and Innoviva reported the U.S. Food and Drug Administration (FDA) has approved Trelegy Ellipta, the first once-daily, three-drugs-in-one inhaler for treatment of chronic obstructive pulmonary disease (COPD). Trelegy Ellipta contains the antimuscarinic umeclidinium, the corticosteroid fluticasone furoate, and the long acting beta agonist vilanterol. The drugs provide bronchodilation and anti-inflammatory effects through three different [… read more]

Sep 142017
 
ICU Physiology in 1000 Words: High Flow Oxygen Therapy

Jon-Emile S. Kenny MD [@heart_lung] That high flow oxygen applied via nasal cannula lends itself to treating hypoxemic respiratory failure may be obvious.  With adequate heat and humidification, oxygen can be employed relatively comfortably at very high flow rates – upwards of 60 L/min – to the nares.  At such rates, the effort of the [… read more]

Sep 082017
 
Angiotensin II, a new vasopressor for septic shock, coming soon (probably)

Physicians may soon have another vasopressor to add to their toolkit in treating patients with septic shock and other vasodilatory shock. Angiotensin II infusions improved blood pressure in critically ill patients with vasodilatory shock who remained hypotensive on high doses of conventional vasopressors, in the phase III ATHOS-3 trial. Patients with hypotension despite catecholamine infusions [… read more]

Sep 082017
 
Tiotropium helped in early COPD in randomized trial

Tiotropium (trade names Spiriva, Stiolto) was originally FDA-approved after patients with severe chronic obstructive pulmonary disease (COPD) had improved lung function and fewer COPD exacerbations taking Spiriva compared to placebo.  In a recent randomized trial of 841 patients in China, tiotropium showed benefits in milder, early COPD as well. Patients with COPD GOLD stage 1 or [… read more]

Aug 302017
 
An Illustrated Guide to the Phases of ARDS: Implications for management

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD “Our life consists partly in madness, partly in wisdom: whoever writes about it merely respectfully and by rule leaves more than half of it behind.” -Montaigne Marking the 50 year anniversary of the first description of the adult respiratory distress syndrome – later [… read more]

Aug 242017
 
Procalcitonin Testing in Suspected Infection: Review

Procalcitonin Test: Overview Procalcitonin (PCT) is the precursor of the hormone calcitonin and is mainly produced by the thyroid. Procalcitonin is a so-called acute phase reactant, rising in response to tissue inflammation and injury. Outside the thyroid, PCT is secreted by the lungs, intestines and other tissues in increasing amounts in response to bacterial endotoxin [… read more]

Aug 232017
 

Scleroderma-Related Interstitial Lung Disease Scleroderma (SSc) is an autoimmune disease characterized by vasculopathy and fibrosis with multi organ involvement. Pulmonary complications such as interstitial lung disease (ILD) and pulmonary hypertension contribute significantly to mortality and morbidity of the disease. Up to 90% patients with scleroderma can have interstitial changes on high resolution CT scan (HRCT) [… read more]

Aug 202017
 
In ARDS, substandard ventilator care is the norm, not the exception

In acute respiratory distress syndrome (ARDS), anyone with the keys to a ventilator knows low tidal volume ventilation (~6 mL/kg ideal body weight) is standard care. Low tidal volume ventilation can prevent or ameliorate ventilator-associated lung injury ; if early clinical trials represent current reality, one in 11 people with ARDS treated by low tidal volume ventilation could have their [… read more]

Aug 202017
 
Contrast induced nephropathy: what's the true risk?

Iodinated IV contrast has long been considered a significant contributor to acute kidney injury in hospitalized patients. But so-called contrast induced nephropathy is hard to accurately identify in real clinical circumstances. Acute kidney injury (AKI) can happen from a variety of causes, or their combination, during acute illness. And no randomized trial has established the risk [… read more]

Aug 092017
 
Heparin-Induced Thrombocytopenia (HIT) Review

HIT Overview Heparin-induced thrombocytopenia (HIT) is a dangerous complication of heparin exposure. In HIT, the body creates an autoantibody against the complex of platelet factor 4 bound to heparin. The anti-PF4 autoantibodies can activate platelets and cause life- and limb-threatening thrombosis in arteries and veins. Platelets generally fall by more than 50% five to ten [… read more]

Jul 292017
 
ICU Physiology in 1000 Words: IVC Collapse, Revisited – Part 2

Jon-Emile S. Kenny MD [@heart_lung] Please read part 1 and view the vodcast on inferior vena cava collapse prior to reading below; this post seeks to explain the interesting findings of Juhl-Olsen & colleagues [1] as well as provide a physiological rationale to Dr. Marik’s comments on my vodcast; there is a new explanatory animation [… read more]

Jul 222017
 
ICU Physiology in 1000 Words: IVC Collapse, Revisited – Part 1

Jon-Emile S. Kenny MD [@heart_lung] Three years ago I wanted to share my physiology website heart-lung.org; I needed a topic to stoke some interest, so I sent a brief essay to Matt here at pulmccm.org.  In it, I briefly described inspiratory IVC collapse and its relationship to volume status and volume responsiveness.  With this, the [… read more]

Jul 082017
 
Intubation during CPR was associated with worse survival and brain health

“Stop chest compressions for a minute while I intubate this patient!” That refrain must have been heard tens of thousands of times during CPR after cardiac arrest before 2010, when the American Heart Association’s (AHA) Advanced Cardiac Life Support (ACLS) guidelines advised resuscitation teams not to interrupt chest compressions to place advanced airways, unless a patient [… read more]

Jun 282017
 

The US Food and Drug Administration (FDA) approved betrixaban (Bevyxxa), a new oral anticoagulant for prevention of venous thromboembolism (VTE) in hospitalized medical patients with risk factors for DVT/PE. With betrixaban, manufacturer Portola will seek to expand a tiny market niche it could immediately dominate: prophylaxis of DVT/PE extending for about a month after hospital [… read more]

Jun 272017
 
Is hypothermia harmful after in-hospital cardiac arrest?

Will “therapeutic” hypothermia someday need to be renamed? After a rush of optimism surrounding small trials showing large benefits from hypothermia to 33° after out-of-hospital cardiac arrest, hospitals and intensivists flocked to provide hypothermia to all victims of cardiac arrest (in- or out-of-hospital). When the much more powerful TTM trial showed no benefit of deep cooling [… read more]

Jun 232017
 
ICU Physiology in 1000 Words: The Mean Systemic Filling Pressure – Part 2

Jon-Emile S. Kenny MD [@heart_lung] Briefly, part 1 of this reflection on the mean systemic filling pressure [Pmsf] considered an analogy for volume status as the vastness of an ocean beyond the hull of a leaking ship; I argue that looking only inside the hull of the ship cannot tell you the volume of the [… read more]

Jun 162017
 
ICU Physiology in 1000 Words: The Mean Systemic Filling Pressure – Part 1

Jon-Emile S. Kenny MD [@heart_lung] It’s 4 in the morning; I am somewhere between Riga and Stockholm.  The moon is full and bright and rippling across the black, Baltic Sea.  This warm, June darkness is cut like onyx by deep vibrations of a cruise ship and its collections of giggling Swedes; they karaoke ‘Spaceman’ by [… read more]

Jun 042017
 
Tight blood sugar control did not help critically ill kids

Remember when intensive glucose control in adults became all the “lifesaving” rage — and was then revealed to actually be harmful? Well, it doesn’t seem to work in kids either. Tight glucose control in critically ill children with hyperglycemia failed to reduce ICU days as compared with a higher target glucose range, in a large randomized [… read more]

Jun 042017
 

The FDA has expanded the indication for tiotropium (Spiriva Respimat) to include children age 6 and older, based on efficacy data similar to that in adults. Tiotropium (Spiriva Respimat) was approved by FDA in 2015 for adults with asthma after clinical trials showed benefit of Spiriva as an add-on therapy to patients with persistent asthma [… read more]

May 152017
 
Sepsis drives far more readmissions than we realized

Sepsis may contribute to far more hospital readmissions than previously recognized — more than any other monitored condition. Recognition of this by federal and private payers could result in increased intensity of oversight of health teams’ care delivery for patients with sepsis. Hospital readmissions are squarely in the sights of the Centers for Medicare and Medicaid [… read more]