PulmCCM - Page 30 of 44 - All the best in pulmonary & critical care
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Aug 312011
 

Grijalva et al analyzed the Nationwide Inpatient Sample (data from U.S. hospitalizations) and found that the rate of hospitalization for parapneumonic empyema doubled from 3 per 100,000 in 1996, to 6 in 2008. The rate of empyemas due to Streptococcus pneumoniae was stable; the increases were in non-pneumococcal infections like Staphylococcus. Mortality was unchanged overall [… read more]

Aug 302011
 

It’s long been known in the pediatric cystic fibrosis population that exacerbations accelerate decline of lung function. de Boer et al show that exacerbations are just as bad or worse in adults. Following 446 adults with CF in Ontario for 3 years, those with >2 exacerbations per year had a hazard ratio of 4.05 for [… read more]

Aug 252011
 

Wisnivesky et al crunched through the SEER data on 3,399 people who underwent resection for N1 non-small cell lung cancer. They found that the number of cancerous lymph nodes predicted survival: 1 positive N1 lymph node: 8.8 years mean lung cancer-specific survival 2-3 positive N1 lymph nodes: 8.2 years 4-8 positive N1 lymph nodes: 6.0 [… read more]

Aug 242011
 

In a crossover design, Kerstjens et al randomized 100 patients with uncontrolled severe asthma (despite high dose inhaled corticosteroid and long-acting beta agonist) to also receive tiotropium 5 mcg, tiotropium 10 mcg, and placebo (in random order) for 8 weeks each. Tiotropium improved peak FEV1 at both doses (increase of 139-170 mL, the primary endpoint). [… read more]

Aug 242011
 

Muscedere J. Subglottic secretion drainage for the prevention of ventilator-associated pneumonia: A systematic review and meta-analysis. Crit Care Med 2011;39:1985-1991. In short, it probably works to prevent ventilator-associated pneumonia (13 randomized trials, n=2,442. 12 were positive, pooled risk ratio 0.55, associated with 1-1.5 shorter days in the ICU and on the ventilator). So why not use [… read more]

Aug 232011
 

An excellent free full text review by Paul O’Byrne. What’s new here: Did you know that formoterol is used as a first-line rescue inhaler, outside the U.S.? Formoterol has a steeper dose-response curve than salmeterol: repeated doses have an additive bronchodilator effect. The use of budesonide/formoterol as a combination maintenance AND rescue inhaler (added prn [… read more]

Aug 232011
 

Obesity was named as a risk factor for severe H1N1 influenza during the pandemic. What about for influenza in general? Kwong et al analyzed community survey data in Ontario over 12 influenza seasons, 1996-2008. Severe obesity (BMI >= 35) carried an odds ratio of 2.1 for respiratory hospitalization during flu season. In those with no [… read more]

Aug 212011
 

For 10 years, Zahar et al prospectively observed 3,588 patients developing severe sepsis & septic shock who ended up in French ICUs. Their sample captured a broad array of infections acquired in the community, the hospital ward, or the ICU (about 1/3 each). After multivariate assessment, they could not find an independent influence on mortality [… read more]

Aug 212011
 

Schuetz et al review the 16 randomized controlled trials (n=4,647) testing procalcitonin-guided vs. standard care on the outcomes of antibiotic use, mortality, and infection control. Most of these studies were done in Europe; 6 were in ICU patients. Using procalcitonin reduced antibiotic use in all settings (primary care, emergency department, ICU) with no detectable differences [… read more]

Aug 202011
 

Obstructive sleep apnea and other sleep disorders have long been associated with cognitive dysfunction, but so far not in a prospective study. So, Yaffe et al followed 298 older women (~82 years) who had already had polysomnography as part of an osteoporosis study. 105 had sleep disordered breathing (cases), defined as an apnea-hypopnea index >= [… read more]

Aug 192011
 

A minority of people develop central sleep apneas during polysomnography with continuous positive airway pressure titration for obstructive sleep apnea. Others develop central apneas later, discovered on interrogation of their CPAP machine. The fact is, no one knows much about this so-called complex sleep apnea — its natural course, prognosis / risks, and whether or [… read more]

Aug 172011
 

Johnson et al reviewed charts in a retrospective case-control cohort study on 754 consecutive patients at Barnes-Jewish with severe sepsis or shock due to Gram-negative bacteremia. The exposure was receipt of antibiotics in the previous 90 days. 310 of the bacteremic patients had received antibiotics previously. Compared to unexposed controls, the previously antibiotic-exposed had a [… read more]

Aug 162011
 

Self-reported adherence is usually overestimated. Most people prescribed chronic daily medication take it ~60% of the time, but say/believe they take it 90% of the time. People with cystic fibrosis are instructed to spend more than an hour a day sitting through up to 7 nebulizer treatments. Daniels et al used a smart nebulizer machine [… read more]

Aug 142011
 

Accountability for Medical Error: Moving Beyond Blame to Advocacy. CHEST 2011;140:519-526.  Bell et al’s great essay on the dysfunctional mechanics and culture of liability / safety / blame surrounding medical errors in hospitals and our medical care system in general. They propose steps toward “collective accountability,” e.g., we MDs should sit on hospital safety committees. But [… read more]