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 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]

Nov 092011
 

Duke’s Momen Wahidi and other luminaries bring you a consensus statement on use of peri-procedure medications during bronchoscopy. I’m assuming you’ve done a few already, so here are some highlights (with slight liberties in paraphrasing): Use topical anesthesia as well as moderate sedation in all patients, unless there are contraindications or you practice at a secret CIA prison. [… read more]

Nov 062011
 

Doctors are generally lousy at predicting death in terminally ill patients, and in ICU patients with indeterminate outcomes. Mortality prediction models have proliferated to improve our performance, but in the critical care literature, have mostly shown high predictive accuracy only at the tail ends of probability (high probability of survival or death). Siontis et al (led [… read more]

Nov 062011
 

Thanks to defibrillators, burly-armed EMTs, speedier cardiac revascularization, and induced hypothermia, the mortality rates after ventricular tachycardia or fibrillation have improved markedly for both in- and out-of-hospital cardiac arrests. But mortality rates after PEA and asystole remain stubbornly steady, seemingly resistant to any of the above interventions. Background: People suffering cardiac arrest in an ICU have the advantage [… read more]

Nov 022011
 

A nice pro/con soundoff between Gerard Silvestri (con) and James Jett & David Midthun (pro) over whether lung cancer screening with chest CT should be national policy, in the wake of the positive findings of the National Lung Screening Trial. Silvestri (of MUSC) argues that we don’t have a handle on the harms of screening [… read more]

Nov 012011
 

October’s Seminars in Respiratory & Critical Care Medicine brings you 110 pages and 11 articles on organ failure in the intensive care unit, with articles including: Organ failure scoring and predictive models Cardiac alterations due to organ failure The microcirculation as a therapeutic target in shock Immuologic derangements in organ failure Acute lung failure Cardiogenic [… read more]

Nov 012011
 

25% of smokers undergoing chest CT have incidentally discovered pulmonary nodules. As questions of national policy re: lung cancer screening with chest CT are considered, Soylemez Wiener et al report the complication rates of 15,865 adults who had transthoracic needle biopsy of a pulmonary nodule in 4 states over the past decade, using a database [… read more]

Nov 012011
 

More than 40 small, middling-quality studies (n~80, some randomized) showing inconsistent results as to whether antioxidant therapy with acetylcysteine or other drugs reduces the risk for contrast nephropathy / acute kidney injury after angiography or CT-angiography. A 2008 meta-analysis concluded Mucomyst was helpful, reducing risk of nephropathy by almost 40% vs saline alone. However, the authors noted [… read more]

Nov 012011
 

In a non-inferiority study, Buhl et al randomized 1,600 adults with moderate or severe COPD to use the new extra-long-acting beta agonist indacaterol 150 mcg or tiotropium 18 mcg inhaled once daily for 12 weeks. At the end of the study period, pre-dose FEV1 improvements were similar in both groups (~125 mL). Indacaterol induced higher post-dose FEV1 improvements [… read more]