PulmCCM - Page 20 of 39 - All the best in pulmonary & critical care
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Dec 262011
 

Targeted temperature management in critical care: A report and recommendations from five professional societies. Nunnally ME et al. Crit Care Med 2011;39:1113-1125. Hypothermia for cardiac arrest guideline. Hypothermia after cardiac arrest review.

Dec 262011
 

Using the Nationwide Inpatient Sample and the national Multiple Cause-of-Death files, Wiener et al found that since the inception of CT-angiography in 1998, the number of CT-PE scans have risen 11-fold, and age-adjusted incidence of pulmonary embolism rose from 62 to 112 per 100,000 (an 81% increase). Over the same period, the mortality rate (presence of PE [... read more]

Dec 262011
 

Wechsler et al randomized and crossed-over 39 subjects with stable asthma to sequentially receive treatment with 1) albuterol; 2) fake albuterol; 3) fake acupuncture, or 4) nothing. Although albuterol improved stable asthmatic subjects’ FEV1 by 20%, they perceived equal improvement in subjective symptoms when given a sham inhaler or a sham acupuncture treatment. (These also [... read more]

Dec 262011
 

Chong J et al review the 23 placebo-randomized trials of just-FDA-approved roflumilast and its sister cilomilast, the oral phosphodiesterase-4 inhibitors. The overall mean improvements in quality of life (1 point on the SGRQ scale) and lung function (46 mL of FEV1) were tiny. The drugs did significantly reduce exacerbations with an odds ratio of 0.78 — as [... read more]

Dec 262011
 

Moores LK et al. Current Approach to the Diagnosis of Acute Nonmassive Pulmonary Embolism. CHEST 2011;140:509-518.  Review. Where is the best area under the curve, or the “overdiagnosis sweet spot?” It seems no approach gets us off the hook as we seek to avoid anticoagulating people without PEs (without missing any, of course): CT-angiography  is more sensitive [... read more]

Dec 262011
 

See Update Below: the larger RELAX trial refuted the results in this small pilot study. Guazzi et al randomized 44 people with heart failure with preserved ejection fraction and associated pulmonary hypertension (confirmed by right heart catheterization) to receive the phosphodiesterase-5 inhibitor sildenafil or placebo for one year, along with standard therapy. Those in the sildenafil [... read more]

Dec 262011
 

Insurance companies, Medicare, and public health authorities haven’t yet sorted out the complexities of the survival benefit found in the Lung Cancer Screening Trial. The number needed to screen to prevent a death was ~300; ~40% of patients had at least one false positive scan, 95% were false positives overall, and overdiagnosis was very likely [... read more]

Dec 262011
 

Singh et al report in a meta-analysis of 14 randomized trials (n=8,216) that varenicline was associated with an odds ratio of 1.72 for serious cardiovascular events compared to placebo. The absolute increased risk was 0.24% (a number needed to harm of 400, while varenicline has a number needed to treat of ~10 to get one [... read more]

Dec 262011
 

The ACP, ACCP, ATS and ERS give us this new clinical practice guideline & review on managing stable COPD. To sum up their recommendations: 1. If symptomatic, those with suspected COPD should be diagnosed with spirometry and offered treatment with bronchodilators if they indeed have COPD. 2. If FEV1 < 60% – then definitely treat [... read more]

Dec 262011
 

Medications are often stopped during transfers of care. Bell et al analyzed administrative-level data for almost 400,000 hospitalizations in Ontario, Canada, as well as 90-day follow-up outpatient prescription data. They conclude that medications were likely to be discontinued after discharge from the hospital or ICU, “potentially unintentionally.” Five medication classes were analyzed (inhalers, anticoagulant/antiplatelets, acid-suppressors, thyroxine [... read more]

Dec 262011
 

Wijesinghe et al randomized and crossed-over 24 people who were recently diagnosed with obesity hypoventilation syndrome to breathe either 100% oxygen or room air for 20 minutes on 2 separate days, while measuring their minute ventilation, expired tidal pCO2, and dead space-to-tidal volume ratio. In 44% of patients, pCO2 increased by at least 4 mm [... read more]

Dec 262011
 

Grainge et al collected bronchial biopsies from 48 allergic asthmatics, then randomly gave them either inhaled dust mite allergen; methacholine; saline (control); or albuterol followed by methacholine (control). Those inhaling allergen or methacholine had immediate bronchoconstriction, followed by an increase in bronchial wall thickness (on repeat bronchial biopsy 4 days later) compared to controls. Dogma [... read more]

Dec 262011
 

The Institute of Medicine has issued stern new guidelines on guideline development. Apparently a good portion of the 2,700 clinical practice guidelines in the Agency of Healthcare Research and Quality’s database are not based on a foundation of good evidence, do not acknowledge when the evidence is shaky, and their authors often have financial conflicts [... read more]

Dec 222011
 

Neither a large 2009 multicenter study nor a 2011 meta-analysis showed any clinical benefit from the use of ICU telemedicine. Lilly et al report the results of a large single-center study in which they progressively implemented ICU telemedicine among 6,290 patients in 7 ICUs (a stepped-wedge design), with non-telemedicine groups acting as controls at each [... read more]

Dec 202011
 

Morales et al queried a database of 53,994 UK asthma patients, finding 1527 who were prescribed beta blockers, 441 with a brand-new prescription. The rate of oral steroid use in the 2 weeks prior to beta-blocker commencement was the same as in the 2 weeks after (0.9%). They did not examine exacerbation rates or steroid [... read more]

Dec 182011
 

Dumas et al prospectively observed 1145 consecutive victims of out-of-hospital cardiac arrest who survived to admission in France between 2000 and 2009. Among VT/VF patients, 65% got therapeutic hypothermia, while 60% of PEA/asystole patients did, with higher proportions receiving hypothermia later in the study period (86 and 73% respectively) . Most people in the PEA/asystole [... read more]

Dec 182011
 

For one year, Dallas et al prospectively followed 2,060 intubated MICU/SICU patients at Barnes-Jewish, and concluded that 83 (4%) developed VAP and 28 (1.4%) got VAT, which was defined as fever and 100,000 CFUs in tracheal secretions, without an infiltrate. By their reckoning, a third of VATs progressed to VAPs. Pathogens (mainly MDR bacteria) overlapped. [... read more]