PulmCCM - Page 30 of 43 - All the best in pulmonary & critical care
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]

Aug 132011

Unimpressed by the unimpressive results of the CAPACITY trials testing pirfenidone for idiopathic pulmonary fibrosis, the FDA bucked its advisory panel (which had recommended approval) and insisted on another randomized trial in order to reconsider the drug. In July 2011 InterMune started enrollment for ASCEND, which plans to provide results on pirfenidone vs. placebo in [… read more]

Aug 112011

Do we need to worry about pre-existing heparin-induced thrombocytopenia antibodies in people admitted with pulmonary embolism / deep venous thrombosis? Or can we keep happily slinging heparin at first sight? Warkentin et al analyze data from the Matisse VTE studies, which enrolled 3,994 patients with DVT or PE. All had ELISA HIT antibodies collected at [… read more]

Aug 102011

In the “why didn’t I think of that?” department: Menzies et al performed pleural fluid sampling on 62 patients with clinical pleural infection, and sent samples to the lab in both standard tubes and in blood culture bottles inoculated at the bedside. 20 standard samples were culture-positive; adding the positive inoculated samples identified an additional [… read more]

Aug 092011

Hersh et al analyzed spirometry and patient-reported data on family history from the COPDGene study, comparing 821 people with COPD to 776 smoking controls. Subject-recalled parental history of COPD had an odds ratio of 1.7 for COPD in the subject. The population attributable risk from family history for COPD was 18.6%. They acknowledge the vulnerability [… read more]

Aug 082011

Mavros et al did the heavy lifting required to review 998 studies relating in some way to atelectasis and postoperative fever. They felt only 8 of those studies deserved analysis (990 were excluded either for not reporting sufficient data, or not focusing on the question at hand). One study reported an association between atelectasis and [… read more]

Aug 072011

Hartwig et al report a series of 157 people receiving fundoplication within 1 year after lung transplant, for reflux diagnosed by abnormal esophageal pH probe. They compared these to 65 with reflux who did not undergo fundoplication. The surgical patients had about 10% higher FEV1s, both at peak and at one year. This was not [… read more]

Aug 062011

Darling et al report findings from the Early Lung PET trial for non-small cell lung cancer. PET-CT had 70% sensitivity and 94% specificity for identifying cancerous mediastinal lymph nodes (with invasive staging as the reference standard). Sounds good. However, among the 22 patients with PET-CT scans positive for mediastinal nodes, 8 did not have cancer [… read more]