Dec 182011
 

Who’s the best bronchodilator on the block? In 725 centers, in 25 countries, among COPD’ers with FEV1<=70% (moderate-or-worse) and an exacerbation in the past year, after using tiotropium or salmeterol (double-dummy) for 1 year, the winner is…. Tiotropium … probably! With a time-to-first-exacerbation of 187 vs. 145 days — but only in the quartile of [… read more]

Dec 182011
 

In the longest longitudinal study of acute respiratory distress syndrome (ARDS) yet, Herridge et al followed 109 young survivors of severe ARDS (medians: age 44; Lung Injury Score 3.7 out of 4) in Canada for 5 years, enrolling 1998-2001. Twelve died in the first year. At 5 years, the survivors remained below their pre-ARDS exercise tolerance; they [… read more]

Dec 182011
 

Dalteparin is a low-molecular weight heparin that, unlike enoxaparin, is safe for people with renal failure. Among 3,746 ICU patients in 6 countries, followed until hospital discharge, there was no difference in the rate of proximal deep venous thrombosis (5.1% vs 5.8%, 1′ endpoint) between once-daily dalteparin and twice-daily UFH, as detected by twice-weekly ultrasounds. [… read more]

Dec 182011
 

Lungs from brain-dead or deceased donors are considered unusable 85% of the time, worsening waiting-list times and death rates. At a single Toronto center, Cypel et al perfused damaged donor lungs ex-vivo (EVLP; here’s how) for 4 hours, and if their numbers were good (PaO2/FiO2 > 349; less than 15% worsening in compliance, pulmonary vascular resistance and [… read more]

Dec 102011
 

Severe sepsis has had a 35-45% mortality rate in clinical trials. Gagan Kumar et al use national observational data to suggest that while population rates of severe sepsis are increasing, survival has likely improved, with mortality falling from 39% to 27%, 2000-2007. However, most of the new survivors are not going home, but rather to [… read more]

Dec 082011
 

A handful of people with pulmonary embolism have absolute contraindications to anticoagulation. Authors here describe these as: Any prior intracranial hemorrhage, known structural intracranial cerebrovascular disease (eg, arteriovenous malformation), known malignant intracranial neoplasm, ischemic stroke within 3 months, suspected aortic dissection, active bleeding or bleeding diathesis, recent surgery encroaching on the spinal canal or brain, [… read more]

Dec 072011
 
Trouble sleeping? Don't read this, it'll only make it worse

If you spend your nights lying awake worrying about having a heart attack, you’re entirely justified. But you’re probably just making it more likely. Lars Laugsand et al followed 52,610 Norwegian people for 11 years after the subjects completed an initial survey (investigators can do this in Norway, since they’ve got everyone’s health records in [… read more]

Dec 052011
 

Sildenafil looks to be reasonably safe and efficacious for long-term treatment of pulmonary arterial hypertension with NYHA class II or III symptoms, according to results of the SUPER-2 trial. This was an extension of SUPER-1, reported in NEJM 2005, which was a 12-week randomized trial in people with PAH and NYHA II/III symptoms, in which those taking [… read more]

Dec 022011
 

Faced with steadily rising costs of medical care insurance, more and more U.S. employers are insisting that smokers pay a higher share of the premiums of their employer-sponsored insurance, according to a Towers Watson survey of 248 businesses.  19% of companies with >1,000 employees have increased smokers’ share of medical care insurance premiums, double the rate from [… read more]

Nov 262011
 

Many people with chronic respiratory failure literally waste away — as evidenced by the contribution of “B” (for body mass index) in the BODE index’s prediction of survival in severe COPD. Although long-term oxygen therapy improves survival and quality of life, and pulmonary rehabilitation improves exercise capacity and QOL, efforts to halt or reverse the [… read more]

Nov 252011
 

According to compelling new data, you can win the genetic lottery and live healthy all your life, and you’ll still be more likely to die from your first heart attack than the diabetic guy in the next bed who keeps going outside to smoke to relieve his chest pain. But you’ll at least have had more time [… read more]

Nov 242011
 

Even my neighbor’s cat knows that giving high-concentration oxygen to people with COPD and acute hypercapneic respiratory failure can cause them to hypoventilate further, causing life-threatening respiratory failure. (And he’s not even a very smart cat.) Perrin, Beasley et al asked, does a similar mechanism operate in severe asthma exacerbations? They randomized 106 patients presenting [… read more]

Nov 222011
 

As Sancho et al point out here, there is a paucity of information available about tracheotomy in amyotrophic lateral sclerosis — when it’s best to perform the life-prolonging surgery, as well as what patients, families, and physicians can expect afterward. They followed 116 patients with ALS; 76 were recommended to receive tracheotomy when they could [… read more]

Nov 172011
 

Most people with cystic fibrosis have mutations in the CFTR gene that prevent sufficient quantities of the assembled channels from making it to the cell membrane surface. That’s a hard problem to fix. However, a small minority (4-5%) have mutations on the G551D allele that impair the function of  the CFTR ion channel once it [… read more]

Nov 162011
 

Chronic thromboembolic pulmonary hypertension is a “new” condition (in terms of our recognition and understanding of it), whose true prevalence, natural history, and response to therapies continue to be elucidated. Meanwhile, specialized surgical centers continually make thromboendarterectomy safer, providing definitive cures that are nothing short of miraculous for those affected by this otherwise usually fatal [… read more]

Nov 122011
 

Intracranial hemorrhage is a subject neuro-intensivists spend years learning about and refining their knowledge and skills on. A few key points: Myocardial “stunning” with depressed ejection fraction and pulmonary edema should be expected, due to a form of tako-tsubo cardiomyopathy, most commonly in subarachnoid hemorrhage. It’s not due to ischemia and gets better over weeks. [… read more]

Nov 112011
 

Obesity may impose extra burdens on critical care staff (think turning, transport, intubation and central line placement), but reviews suggest people with “ordinary” obesity (BMI 30-39) with have the same mortality from critical illness as overweight or healthy-weight people. In fact, obese people may have a survival advantage, despite possible longer durations of mechanical ventilation and ICU stays. But what about extreme obesity (BMI > [… read more]