Cystic Fibrosis 2012 Update (Review, AJRCCM)

Cystic Fibrosis 2012 Review (More 2012 Topic Updates) From the excellent summary by Felix Ratjen (U-Toronto) and Susanna McColley (Northwestern) in the May 2012 AJRCCM (Blue Journal), and our own cystic fibrosis literature review. Pulmonary Infection in Cystic Fibrosis The standard practice of early eradication of Pseudomonas aeruginosa in cystic fibrosis patients — giving inhaled [... read more]

Non-ST elevation myocardial infarction & unstable angina (Review, AJRCCM)

Non-ST Elevation Myocardial Infarction (NSTEMI) and Unstable Angina (UA): 2012 Review (More 2012 Topic Updates) From concise clinical reviews by the don of cardiovascular disease, Eugene Braunwald (Harvard) in the May AJRCCM (Blue Journal) and Jeff Trost (Johns Hopkins) in Critical Care Medicine. These review articles on the diagnosis and treatment of non-ST-elevation acute coronary syndrome or NSTE-ACS (NSTE-myocardial infarction and unstable [... read more]

Where’s the respect (and $$) for critical care research? (Crit Care Med)

(image: Suburban Wino) Craig Coopersmith of Emory is an amazing guy and a prolific investigator in critical care — and it looks like he’s fed up with having his grants rejected. After some epic bean-counting, his group concludes that critical care research gets short shrift in federal research funding, compared to the huge amounts spent [... read more]

Chantix: no excess cardiovascular risk in new meta-analysis (BMJ)

(image: People’s Pharmacy) Sure to re-light controversy around Pfizer’s varenicline (Chantix): a new study concludes the smoking cessation drug likely carries no increased risk for cardiovascular events.  Judith Prochaska and Joan Hilton (University of California – San Francisco) report the results in the May 4 BMJ. Sonal Singh (Johns Hopkins) et al’s previous meta-analysis, reported in CMAJ [... read more]

Mechanical Ventilation in ARDS: 2012 Update

Mechanical Ventilation in ARDS: 2012 Review (More 2012 Topic Updates) People with acute respiratory distress syndrome (ARDS) are by definition severely hypoxemic, and nearly all require invasive mechanical ventilation. Yet mechanical ventilation itself can further injure damaged lungs (so-called ventilator-induced lung injury); minimizing any additional damage while maintaining adequate gas exchange (“compatible with life”) is the [... read more]

Acetaminophen causes childhood asthma, researcher argues (Pediatrics)

(image: flickrCC) Is acetaminophen responsible for the worldwide rise in childhood asthma over the past 30 years? Citing a mounting pile of circumstantial evidence from epidemiologic observational studies, John McBride of Akron’s Children’s Hospital in Ohio believes so, and that it’s time to officially push the worry button. The theory is that the fear of aspirin-induced [... read more]

How to bill for palliative care in the ICU … legally (Chest)

Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [... read more]

Do you have cooties? MDR-bug transmission rates in ICUs (Crit Care Med)

(image: flickrCC) Foam in, foam out, gown on, gown off … ah, the tedium of practicing critical care medicine in the age of rampant, lethal, multi-drug resistant bacteria. As a reminder to keep your guard up and your gear on, here’s a yucky study from Daniel Morgan, Elizabeth Rogawski, and Anthony Harris of the University [... read more]

Stop yelling, dear, you’re hurting Jimmy’s lungs (AJRCCM)

(image: nict.budocentral.com) Air pollution exposure seems to worsen lung function, and low-income children seem particularly vulnerable. One proposed reason for their susceptibility is co-exposure to high parental stress, which is worse in low-income families. Although that may sound hokey, psychosocial stress has been shown to increase oxidative stress, airway inflammation, and steroid resistance. (These findings [... read more]

Oral rivaroxaban (Xarelto) noninferior to warfarin for PE (RCT, NEJM)

(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [... read more]