Nov 232012
 
Intensive glucose control in kids: no brain injury vs. standard care 3 yrs later (RCT)

Intensive Glucose Control: Safe for Critically Ill Kids’ Brains? After evangelizing globally for intensive glucose control (~100 mg/dL) to be the standard of care for virtually all critically ill adults for a decade, Greet van den Berghe might be disappointed that mounting evidence shows that a fanatical approach to maintenance of normoglycemia in critical illness [… read more]

Nov 202012
 
New pleural mesothelioma biomarker can speed diagnosis

(image: Wikipedia) Pleural Mesothelioma Biomarker Fibulin-3: Could It Improve Care? Pleural mesothelioma (malignant mesothelioma) has a dismally sad prognosis of about a year after diagnosis. Earlier detection of this lethal pleural cancer could conceivably result in earlier treatment and some improvement in life expectancy. Researchers report in the October 11, 2012 New England Journal of [… read more]

Nov 162012
 
Supraventricular Tachycardia (SVT): Initial Diagnosis and Treatment (Review)

Supraventricular Tachycardia, Initial Diagnosis and Treatment When supraventricular tachycardia (SVT) causes symptoms, it requires immediate medical attention.  Although many physicians believe that the precise type of SVT must be identified before providing treatment, this is not true: treatment can often be started safely and effectively without knowing the exact SVT, by tailoring it to the [… read more]

Nov 142012
 
New lung tissue growth can occur in adults, defying previous belief

New Lung Tissue Growth Discovered: Is Some Lung Regeneration Possible? Lung regeneration has never been thought possible in adults. But Steven Mentzer et al from Brigham and Women’s at Harvard reported a case of a 33 year old woman who had an apparent 64% increase in the number of functioning alveoli in her left lung, during [… read more]

Nov 092012
 
Do people with pulmonary hypertension need in-flight oxygen?

Is In-Flight Oxygen for Pulmonary Hypertension Necessary? After finding a high rate of symptoms among people with pulmonary hypertension during commercial air flights, Nareg Roubinian, C. Gregory Elliott, and Hubert Chen are recommending that everyone with significant pulmonary hypertension planning to take a flight longer than 2.5 hours should be evaluated for supplemental in-flight oxygen. [… read more]

Nov 062012
 
Lung volume reduction coils improve dyspnea, FEV1 in COPD (RCT)

(image: PneumRx) ATLANTA — In a small, open-label pilot study, bronchoscopically-placed metal coils that retract emphysematous lung, creating lung volume reduction without surgery, produced functional and airflow improvements in a majority of patients with severe COPD, the lead researcher reported at CHEST 2012. Investigators randomized 47 patients with severe emphysema type COPD to undergo either [… read more]

Oct 312012
 
Hospital-acquired infections: stopping Gov't payment did not reduce their incidence

Preventing Hospital Acquired Infections: Stopping Payment Had No Effect In October 2008, the U.S. Centers for Medicare and Medicaid Services (CMS) stopped paying for two hospital-acquired infections: urinary infections due to indwelling catheters (UTIs) and central catheter-associated bloodstream infections (CABSI). At the time the policy was announced years ago, it was described as an incentive [… read more]

Oct 262012
 
Vitamin D is for "doesn't do diddly" for the common cold (RCT)

Extra Vitamin D Doesn’t Prevent Colds in Healthy Adults (JAMA) It looks like you can add Vitamin D to list of supplements (echinacea, vitamin C, etc.) who’ve gone up against the common cold and lost. (Scorekeepers will note that zinc held its own, though, in a Cochrane analysis.) Vitamin D plays an important role in immune responses, [… read more]

Oct 192012
 
"Practice ischemia" on an arm reduces contrast nephropathy after procedures (RCT)

Contrast-induced nephropathy (kidney damage) is a serious problem that can occur after many medical tests and procedures, but coronary angiography (cardiac catheterization) is the main culprit. People with pre-existing renal disease are most susceptible to contrast-induced nephropathy (CIN) — about 1 in 8 of them develop a “bump” in creatinine of >0.5 mg/dL after cardiac [… read more]

Oct 042012
 
Post-pyloric feeding no better than usual NG tube in vented patients (RCT)

Image: EIMJM.com Evidence-based practice guidelines adopted by critical care societies in Canada, Germany, Australia and New Zealand recommend starting enteral nutrition for critical illness shortly after admission to an ICU. In observational studies, critically ill adults get only about 50-70% their caloric goals from enteral feeding; reduced gastric motility is often responsible for the limited [… read more]

Sep 302012
 
Treatment of Acute Deep Vein Thrombosis (DVT) of the Arm (Review/Guideline)

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Sep 202012
 
Gabapentin improved chronic cough in randomized trial

Chronic cough is the scourge both of the coughers themselves, and the doctors who treat them. Although rarely medically serious, chronic cough can be surprisingly debilitating by disrupting sufferers’ social and professional lives. Doctors, for their part, often feel frustrated and powerless in treating chronic cough. Although gastroesophageal reflux disease (GERD), asthma, ACE inhibitor use, [… read more]

Sep 162012
 
Initial Treatment of Acute Deep Venous Thrombosis (DVT) of the Leg (Guidelines)

The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.

Sep 122012
 
Anemia in the ICU (Review)

Anemia in the ICU: Review and Update (More PulmCCM Topic Updates) This document will be updated periodically to incorporate new research findings. To suggest an article for inclusion, please comment below. Anemia is almost inevitable during many episodes of critical illness, and has been associated with worsened outcomes and prognosis. However, the preponderance of evidence suggests that correcting anemia [… read more]

Sep 042012
 
Hyperosmolar Therapy for Increased Intracranial Pressure (Review)

Hypertonic Saline & Mannitol for Raised Intracranial Pressure (More PulmCCM Topic Updates) Acute brain injuries of all sorts increase the pressure inside the skull (intracranial pressure). Traumatic brain injury, bleeding in or around the brain, severe ischemic stroke, and acute hepatic failure all raise intracranial pressure, and increased intracranial pressure often becomes the most severe [… read more]

Sep 022012
 

Definition of Severe Sepsis by the Surviving Sepsis Guidelines Severe sepsis is sepsis (known or suspected infection with systemic manifestations of sepsis) along with sepsis-related tissue hypoperfusion or organ dysfunction. Organ dysfunction or tissue hypoperfusion are defined by the Surviving Sepsis Campaign as any of the below signs or findings: Signs of Severe Sepsis: Organ [… read more]