PulmCCM - Page 20 of 40 - All the best in pulmonary & critical care
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Jan 012012
 

This nice (and brief) review article on interpreting elevated troponin levels can be summed up by its quote from cardiologist Robert Jesse: “When troponin was a lousy assay it was a great test, but now that it’s becoming a great assay, it’s getting to be a lousy test.” Troponin abnormality is set at the 99th [... read more]

Jan 012012
 

Macrolide antibiotics are increasingly recognized for their salutary anti-inflammatory effects in lung disease, potentially distinct from any antimicrobial effect. Albert et al report that among 1,142 people with severe COPD (FEV1 ~40% predicted) who were randomized to take either azithromycin 250 mg or placebo daily for one year, those taking azithromycin had fewer exacerbations, as [... read more]

Jan 012012
 

Cytisine is a partial nicotine agonist extracted from acacia seeds. In a single-center trial, West et al randomized 740 smokers to receive either cytisine or placebo for 25 days; they were then followed for 12 months with surveys and periodic biochemical verification. At 12 months, those receiving cytisine had an 8.4% rate of biochemically verified [... read more]

Jan 012012
 

Every July, 100,000 house staff change jobs, with the sudden arrival of huge cohorts of promising talented young interns who also happen to be (by definition, and speaking from personal experience) disoriented and incompetent. Does changeover result in excess mortality — the so-called “July effect” in the U.S. (in the U.K., they go right ahead and [... read more]

Jan 012012
 

Medical tradition and lore advised follow-up chest films for asymptomatic people 6 weeks after pneumonia to see if a lung cancer might be lurking there. IDSA guidelines from 2007 don’t address the question, and UK guidelines suggest a follow-up chest X-ray only in those with a smoking history or over age 50. Using databases, Tang [... read more]

Jan 012012
 

Numerous small (n~100), single-center randomized trials have shown a benefit of omega-3 fatty acids in acute lung injury and ARDS (reduced mortality, length of stay, and organ failure; improved oxygenation and respiratory mechanics). A meta-analysis combining these studies suggested a stat.significant benefit in mortality (risk ratio 0.67), ventilator requirement (-5 days), and ICU stay (-4 [... read more]

Jan 012012
 

Air Travel for Patients with Lung Disease (BTS Recommendations) Some interesting facts, figures, and recommendations on air travel for those with chronic lung disease, thanks to Ahmedzai et al who produced this 32 page document for the British Thoracic Society: At 8,000 feet in a commercial aircraft, you’re breathing 15% O2, and normal people’s SpO2 [... read more]

Jan 012012
 

The smoking cessation drug varenicline (Chantix) got a black-box warning in 2009 after the FDA received >500 reports of suicidal thoughts and behaviors, and 32 completed suicides in the U.S. (This was out of several million prescriptions filled, though.) After that postmarketing surprise, the FDA sponsored 2 observational studies in Chantix users: one at the [... read more]

Jan 012012
 

Faster recovery from severe sepsis (or other disorders causing patchy/global hypoperfusion) should be accompanied by a faster disappearance of lactate from the bloodstream. The rate of lactate clearance was reported by Nguyen et al in Crit Care Med 2004 (among others) to predict survival from septic shock, and a strategy substituting lactate clearance of 10% for [... read more]

Jan 012012
 

The National Lung Screening Trial demonstrated annual screening with chest CT saves one life per 320 screened compared to yearly screening with chest radiography. However, there was no “usual care” group (no screening at all) to compare against. Oken et al report additional results from the PLCO Trial (Prostate, Lung, Colorectal, and Ovarian Cancer Screening [... read more]

Jan 012012
 

After receiving hundreds of postmarketing adverse event reports of suicidal thoughts or behaviors (and 32 completed suicides) associated with smoking cessation drug varenicline (Chantix), the FDA slapped a black box warning on the med in 2009 and commissioned two large retrospective observational studies totaling more than 40,000 patients starting either varenicline (Chantix) or nicotine replacement. [... read more]

Jan 012012
 

Quitting smoking is astoundingly difficult: only about 3% stay quit at 6 months without help. Using nicotine replacement therapy increases that to 9%. The more effective but often-maligned drug Chantix (varenicline) increases it to up to 33% at six months, but after a year, smoking cessation rates even with varenicline may fall to only 11% over [... read more]

Jan 012012
 

Severe sepsis makes the heart irritable, probably due to all the evil humors and increased cardiac demand. Between 6-20% of patients with severe sepsis develop atrial fibrillation for the first time; that’s old news. What’s been unclear is what new-onset atrial fibrillation in severe sepsis means: is it an expected, yeah-so-what marker of critical illness, [... read more]

Jan 012012
 

Ultrasound is the future. It’s even better than that: it’s the present. So say proponents Seth Koenig, Mangala Narasimhan and pioneer & innovator Paul Mayo in this month’s CHEST review. They endorse a “paradigm shift” meaning, in effect, you get professionally trained on this highly versatile, effective, and immediate-results-providing modality and integrate it into your routine [... read more]

Jan 012012
 

Each individual episode of critical illness produces a mushroom cloud of data, most of which dissipates without being recorded at all (think realtime infusion rates of vasopressors and continuous ECG monitoring). A few large databases capture outcomes data from multiple participating hospitals (like the National Inpatient Sample), and the new MIMIC-II integrated data system can [... read more]

Dec 272011
 

COPD is a progressive disease causing inexorable decline in lung function, right? We were all taught it, but maybe no one checked first. Vestbo et al’s ECLIPSE, a simple but large and elegant observational study that continues to furnish new insights into COPD, shows the truth is far more nuanced and complicated. After following 2,163 patients with COPD of [... read more]

Dec 262011
 

Noble et al report results of two Phase III placebo-controlled trials in N. America and Europe, with 779 patients total. In one trial, pirfenidone reduced FVC decline by ~4% at 72 weeks; in the other, it did not; pooling all the data, pirfenidone reduced FVC decline by 2.5% compared to placebo. There were abundant mild [... read more]

Dec 262011
 

Walkey et al combined 8 randomized trials including 1,641 people with MRSA pneumonia, and found no significant differences between those treated with linezolid or vancomycin in survival, resolution of clinical pneumonia, eradication from sputum of MRSA, or adverse events. Authors dispute linezolid’s supposedly higher lung penetration, pointing out that that dogma evolved from studies of healthy people; [... read more]

Dec 262011
 

Webb and Samuels (Emory neuro-intensivists) report on a brain-injured patient who, after induced hypothermia and rewarming, had absent brainstem function and a confirmatory apnea test. However, in the O.R. for organ donation 24 hours later, brainstem function transiently returned and the surgery had to be aborted. They urge caution to the rest of us in [... read more]