PulmCCM - Page 30 of 42 - All the best in pulmonary & critical care
Jul 152011

3% saline infusions have become standard care for increased intracranial pressure at many centers, based on mostly anecdotal evidence. Hauer et al looked retrospectively at 100 patients receiving 3% saline for severe stroke in 2008-2009 (intracerebral hemorrhage, subarachnoid hemorrhage, or ischemic) and compared them to 115 historical controls, 2007-2008 with “equal” underlying disease. Hypertonic saline [… read more]

Jul 152011

Lore has it that pure-right sided heart disease in pulmonary arterial hypertension doesn’t cause pleural effusions. Luo et al report here that it does, in 35 of 89 people (39%) with connective-tissue disease-related PAH. (29 of the 35 had no other discernible cause for the effusion.) CHEST 2011;140:42-47. Their group previously reported that people with [… read more]

Jul 152011

Teo et al randomized 24 people with newly diagnosed obstructive sleep apnea (AHI > 15) to crossover between nasal and oronasal (full-face) masks during 2 consecutive nights of CPAP titration. The nasal mask had more leaks and people wearing it had more arousals. However, they liked it better than the face mask, and there was [… read more]

Jul 152011

In a prospective observational study of hospitalized patients with pneumonia, 20% met criteria for HCAP. Those with health care associated pneumonia were sicker of course, but it was impossible to tease out attributable mortality due to the multitude of interrelated confounders present. Antibiotic resistant organisms per se were not shown to cause death often enough [… read more]

Jul 142011

Tranexamic acid has a small beneficial effect on hemorrhage from trauma or surgery. Among 270 subjects with intracranial hemorrhage due to trauma, those randomized to tranexamic acid showed a trend toward improved outcomes (mortality, hemorrhage extension, new bleeding foci) compared to placebo. Authors propose a large trial to explore further. BMJ 2011;343:d3795. FREE FULL TEXT

Jul 092011

Murphy et al report a pilot study in which they used parasternal electromyography (noninvasive electrode over the 2nd intercostal space) to measure respiratory work in 30 subjects admitted for acute exacerbations of COPD. The so-called neural respiratory drive index predicted clinical recovery and identified patients destined to be readmitted within 14 days. Thorax 2011;66:602-608.

Jul 062011

Singanayagam et al prospectively observed 490 COPD patients admitted for community acquired pneumonia with COPD; 77% were using inhaled corticosteroids. As would be expected, ICS users had worse COPD (higher GOLD stage) than non-ICS-users. There were no differences between cohorts in pneumonia severity, mortality at 30 or 180 days, or requirement for mechanical ventilation or [… read more]

Jul 052011

Why are big single center trial effects not often replicated in larger multi-center randomized controlled trials? Dechartres et al did a meta-meta-analysis on 48 meta-analyses comprising 421 randomized clinical trials. Across all their sensitivity analyses, reported treatment effects were consistently and substantially larger in single-center trials than in multi-center trials. No one knows why yet. [… read more]

Jul 042011

Chapman et al extended their 6-month Phase III trial for once-daily long-acting beta agonist indacaterol for another 6 months. FEV1 improvements of 170 mL, reduced albuterol use of 1 puff / day, and slight absolute decreases in exacerbation rates were all preserved, without evidence of tolerance or increased adverse events. The drug made about 24% [… read more]

Jul 032011

Fragou et al randomized 401 ICU patients to undergo subclavian vein central line placement with guidance either by ultrasound or anatomic landmarks. All cannulations were with an infraclavicular approach. The ultrasound group had a higher success rate (100% vs 87.5%), shorter time to access and fewer number of attempts, and a lower rate of complications. [… read more]

Jul 022011

Stapleton et al report results of a phase II trial of 14 days of omega-3 fish oil vs. placebo in 90 people with acute lung injury or ARDS. There was no difference in the primary endpoint (inflammatory marker IL-8 in BAL fluid), nor in any clinical outcome. Crit Care Med 2011;39:1655-1662.

Jul 022011

Aujesky et al randomized 344 people in 19 European emergency departments with low-risk pulmonary embolism to either be sent home with enoxaparin and warfarin within one day, or to be treated until therapeutic on warfarin in-hospital. They were then treated for 90 days. One of 171 home-treated patients developed recurrent VTE, while none of the [… read more]