PulmCCM - Page 20 of 41 - All the best in pulmonary & critical care
Advertisement
Jan 212012
 

People who survive the initial hyperinflammatory “cytokine storm” of severe sepsis regain their blood pressure, but are at high risk for secondary infection and viral reactivation. Animal models strongly suggest sepsis-induced immune suppression occurring later in the course of sepsis is to blame, but that’s never been proven in humans. Jonathan Boomer, Kathleen To, Richard [… read more]

Jan 212012
 
Omitting heparin prophylaxis in first 24 ICU hours associated with higher mortality (CHEST)

As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [… read more]

Jan 202012
 

Richard Light and friends established that parapneumonic effusions (PPE) associated with community-acquired pneumonia very rarely progress if the effusion is freely layering and less than 1 cm in height on a lateral decubitus chest film. But who orders those anymore? Chest CT use has risen 20-fold since Light’s seminal 1980 paper. Often the CT has [… read more]

Jan 192012
 

A 40-year old asthmatic woman coughed the corner of her right lower lobe right through her chest wall, needing a thoracotomy to repair it. She seemed to have recovered well at 3-month follow-up. Matthew O’Shea and Morgan Cleasby of Good Hope Hospital in Birmingham (United Kingdom) share their fascinating pictures in a New England Journal show-and-tell. [… read more]

Jan 152012
 

Himani Gupta, Prateek Gupta, and Lee Morrow of Creighton have done us all a favor by mining a national database (the National Surgical Quality Improvement Program) to create and validate a risk calculator for perioperative pulmonary complications, which they unveil in the November CHEST. Pulmonologists are consulted every day to weigh in on the risk [… read more]

Jan 142012
 

When given to people with acute exacerbations of chronic obstructive pulmonary disease, corticosteroids aren’t proven to reduce mortality, but they improve FEV1, reduce hospitalization by ~1 day, and increase 30-day treatment success, according to a 2009 Cochrane review of 10 randomized trials. Patients in ICUs were excluded from the analyzed studies, and it’s unclear whether steroids are [… read more]

Jan 122012
 
How to cure abdominal compartment syndrome without surgery (CHEST)

Intra-abdominal hypertension (defined as a sustained urinary bladder pressure > 12 mm Hg) may be an under-recognized problem in the ICU, especially in patients after abdominal surgery or who have gone massive volume resuscitation with blood and/or fluids (think hemorrhage, burns and sepsis). When high abdominal pressures (> 20 mm Hg sustained) cause organ failure and/or [… read more]

Jan 112012
 
13 doses rifapentine + isoniazid as good as 9 months INH for latent TB (RCT, NEJM)

Nine months is a long time to take daily isoniazid — and an even longer time to go without beer. If you have latent tuberculosis infection (LTBI) diagnosed by a positive tuberculin skin test, and you make it through a year or 2 without developing active TB, your lifetime risk of reactivation TB (given a healthy [… read more]

Jan 082012
 
Early tracheostomy doesn't improve outcomes ... much (Meta-analysis, CHEST)

[poll id=”3″] A 2005 meta-analysis of 5 studies (n=406) concluded that early tracheostomy reduced need for mechanical ventilation and ICU days. But then a 2006 randomized trial in trauma patients found no benefit to early trach, and an underpowered 2008 RCT also found no benefit. In a new meta-analysis and systematic review of 7 trials (n=1,044), Fei [… read more]

Jan 082012
 
Elderly critically ill who survive ICU rationing live well (CHEST)

Many argue that as a limited resource serving unlimited needs, medical care is “rationed” by definition, and ICU resources (being more limited and expensive) are simply more overtly rationed. For example, in France, ICU admission is often denied to the very elderly critically ill, explicitly because of their age (this happens in the U.K., too, probably). In the U.S., [… read more]

Jan 072012
 
Don't text-and-doctor, authorities warn (NYT)

Neurosurgeons making personal calls during brain surgery; intensivists shopping Amazon in the ICU; residents zoning out on rounds to check Facebook. Doctors aren’t innocent of indulging the national obsession with electronic devices while at work, and our foibles are exposed here in a fussbudget New York Times “trend” piece. There’s no real data to support the [… read more]

Jan 072012
 
Sleepy cops abound; you won't like them when they're angry (JAMA, NYT)

Did you ever wonder what that police officer is really doing while you wait forever in your car for him to write you your ticket? According to new research, it’s possible he’s taking a quick nap. And you’d best save your snarky comment when he brings you the citation: sleepy cops, it turns out, tend to be [… read more]

Jan 072012
 

One thing I thought I knew was that overweight and obesity cause coronary artery disease and make it worse. People with CAD who are obese should lose weight … right? Recent research shows it’s not that simple (although the answer is still “yes, probably”). Did you know about the “obesity paradox?” Or the “lean paradox,” [… read more]

Jan 072012
 
Neti pots kill 2 after transmitting brain-eating amoeba

In December 2011, The Louisiana Department of Health and Hospitals reported the first two cases of death-by-neti-pot. Both deaths were due to lethal encephalitis caused by Naegleria fowleri, a freshwater amoeba. The first victim, a 20-year old man, died in June; it was known that he had used a neti pot, but the connection was [… read more]

Jan 062012
 
Big bucks riding on FDA's little dosing decision for indacaterol (NEJM)

In July 2011, FDA approved indacaterol, Novartis’s new once-daily long-acting beta agonist, for the treatment of chronic obstructive pulmonary disease. In contrast to its European counterpart (EMA), which approved indacaterol there at doses up to 300 mcg, FDA only approved indacaterol in the 75 mcg daily dose. The FDA’s Badrul Chowdhury explains why in the [… read more]

Jan 022012
 
FDA approves Aclidinium (Tudorza Pressair), a b.i.d. "me-too" to Spiriva for COPD

July 29, 2012 Last week, the FDA approved aclidinium bromide (Tudorza Pressair) as a daily inhaler treatment for chronic obstructive pulmonary disease (COPD), the agency announced in a press release. Aclidinium is a long-acting muscarinic antagonist (or “anticholinergic”) bronchodilator that will compete with tiotropium (Spiriva), which was launched in 2004 and until now was the [… read more]

Jan 012012
 
ACP advises against universal DVT/PE prophylaxis! "Quality" quagmire thickens (Guideline/Review, Ann Intern Med)

Daunted by the seeming impossibility of measuring and comparing hospitals on real outcomes (given our primitive state of data collection and heterogeneity in patient populations, among many other challenges), well-meaning bureaucrats and non-profiteering safety advocates like the Institute for Healthcare Improvement have created directives based on surrogate measures in an attempt to standardize and improve [… read more]

Jan 012012
 
Xigris X'd! PROWESS-SHOCK negative; activated protein C yanked from global market

A newer post is available reviewing the final published findings for PROWESS-SHOCK in NEJM. PROWESS-SHOCK results are in, and they sounded the death knell for drotecogin alfa (activated protein C / Xigris), Eli Lilly’s often-challenged blockbuster drug for septic shock. Investigators reported a 28-day all-cause mortality rate of 26.4% in patients treated with activated drotrecogin [… read more]

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]