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Mar 042012
 

It wasn’t such a crazy idea, injecting beta-agonists continuously into the veins of people with acute respiratory distress syndrome (ARDS) for a week. After all, if you spray some albuterol on alveolar epithelial cells in a dish, it upregulates their cAMP production and doubles the rate at which they clear fluid across their basement membranes. [… read more]

Mar 022012
 
Walk to wean: Early mobilization for ventilated patients (Review, CHEST)

Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress and William Schweickert have turned their attention to early mobilization as the next intervention that could help mechanically ventilated patients escape the ventilator faster. [… read more]

Feb 292012
 
"First dibs" on patients by sleep docs increased CPAP adherence (CHEST)

In the face of criticism from insurers and the government for a perceived excessive zeal for profits, and mounting evidence that uncomplicated obstructive sleep apnea (OSA) can be diagnosed at home and managed by primary physicians, you can’t blame sleep specialists for feeling down-in-the-mouth lately. Sushmita Pamidi et al report some brighter news in the [… read more]

Feb 282012
 

For unclear reasons, people receiving chemotherapy for solid tumors are at particularly increased risk for deep venous thrombosis and pulmonary embolism (DVT/PE). Semuloparin is an ultra-low-molecular weight heparin with a long half life of 16-20 hours that (like enoxaparin) is renally excreted. Sanofi, makers of Lovenox, report in the February 16 New England Journal of [… read more]

Feb 272012
 

“Medical identity theft” — theft of your unique identifiers to perpetrate Medicare or insurance fraud — may be on the rise, according to the Federal Trade Commission. There were 12,000 cases of medical identity theft reported by patients or doctors between 2007-2009. A JAMA article by Shantanu Agrawal and Peter Budetti describes one hapless victim’s [… read more]

Feb 262012
 

I knew I smelled something fishy about this paper when I read and commented on it last year.  Now, Chest reports they’re giving this study a burial at sea, after the authors could not produce actual data supporting the trial. To help set the record straight: Chest published a retrospective study in March 2011, “Chest Tube [… read more]

Feb 232012
 
For most, plane flights add no DVT/PE risk (just stretch your legs)

As we were all taught in med school, long-distance flights, or even a long car trip, greatly increase your risk for deep venous thrombosis and pulmonary embolism … right? (I feel like I’ve answered about 8 board questions featuring this scenario.) The CDC even has a whole page of guidelines detailing the travel-DVT-risk-connection and the [… read more]

Feb 232012
 

GlaxoSmithKline has a new once-daily inhaled corticosteroid called fluticasone furoate; it has enhanced affinity for glucocorticoid receptors and a longer duration of action compared to the commonly-used fluticasone propionate, which must be taken twice daily to achieve a steady bioavailable concentration. In the January Thorax, William Busse et al report the findings of a Phase [… read more]

Feb 222012
 
Restrictive blood transfusion was fine for high-CV-risk patients after hip fracture repair (RCT, NEJM)

There’s not much data to guide the transfusion of red blood cells. In 1999, there was the beautifully executed and practice-changing Transfusion Requirements in Critical Care (TRICC) trial, which showed that a restrictive transfusion strategy (hemoglobin trigger of 7 g/dL) in ICU patients resulted in a non-stat.significantly lower mortality (19% vs. 23%) compared to a [… read more]

Feb 212012
 
Amoxicillin speeds resolution of acute sinus infections, but imperceptibly? (RCT, JAMA)

Amoxicillin may hasten the recovery from acute sinusitis (sinus infections), with more patients feeling just a tiny bit better after a week of amoxicillin compared to placebo, according to a clinical trial published in the February 15 JAMA. After 10 days, those taking placebo felt as well as those taking antibiotics. You may have heard [… read more]

Feb 192012
 

Traditional bronchoscopy with transbronchial biopsy (TBBx) has only a 34% sensitivity at diagnosing peripheral pulmonary nodules < 2 cm in size. Transthoracic needle aspiration (TTNA)’s superior sensitivity of 90% for diagnosing peripheral lesions makes it the standard of care for peripheral lesions, but TTNA carries a considerable risk for pneumothorax. A huge proportion of patients experience [… read more]

Feb 182012
 

Please also see the newer post describing the final results of PANTHER-IPF, published in NEJM 2012. PANTHER-IPF, a landmark clinical trial testing commonly used therapies for idiopathic pulmonary fibrosis, was stopped in October 2011 for apparent harm caused to patients by prednisone and azathioprine. This news was released back then, but maybe you missed it, as [… read more]

Feb 172012
 
Tobacco warnings, free speech, and "in-activist" judges (NEJM)

Legal eagle Kevin Outterson explains the latest twists in the saga of the FDA’s quest to get large, scary pictures on every cigarette package under its new regulatory muscle of the 2009 Obama-authorized Tobacco Control Act. R.J. Reynolds sued, and federal judge Richard Leon took their side in November 2011, deciding to apply the more [… read more]

Feb 162012
 

Do you conduct original investigations in respiratory medicine? Are you tired of publishing your work in The New England Journal of Medicine, Science and Nature? Well, Lancet has been feeling left out. They’d like to publish your manuscript(s) in a September 2012 issue to coincide with the European Respiratory Society meeting. They’ve issued a call for [… read more]

Feb 142012
 

Chronic obstructive pulmonary disease (COPD) and congestive heart failure (CHF) are common and together contribute enormously to the global burden of chronic disease. Although surely these conditions overlap and interact, surprisingly little study has been given to their interrelationship. Macchia et al prospectively evaluated and followed two cohorts of patients aged > 59, recruited from [… read more]