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.
Yao et al report a meta-analysis of 8 studies (n=728) measured hydrogen peroxide in exhaled breath condensate in asthmatics. Overall, concentration of H2O2 did distinguish asthmatics from non-asthmatics, and H2O2 levels correlated with worsening asthma control and with declining FEV1. CHEST 2011;140:108-116.
Hyperbaric oxygen in the critically ill. Weaver LK. Crit Care Med 2011;39(7):1784-1791.
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]
Glycemic Control in the ICU. Egi M et al. CHEST 2011;140:212-220. Endocrine, hyperglycemia, review.
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]
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]
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]
Bone Marrow-Derived Stem Cells and Respiratory Disease. Jones CP, Rankin SM. CHEST 2011;140:205-211.
Diseases of the pleura (edited by Richard Light), and neoplasms of the lung (edited by Alan Fein and David Ost). 80 pages. Curr Opin Pulm Med 2011;17(4):215-295.
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.
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]
Airway remodeling and its relationship to inflammation in cystic fibrosis. Regamey N et al. Thorax 2011;66:624-629.
Update on tuberculosis: TB in the early 21st century. Connell DW et al, Eur Resp Rev 2011;20:71-84. FREE FULL TEXT
Improving survival after out-of-hospital cardiac arrest: AHA Consensus Statement. Neumar RW et al. Circulation 2011;123:2898-2910. FREE FULL TEXT. Guideline. Review.
The best approach to nutrition during critical illness is unknown. Casaer et al randomized 4,640 critically-ill patients who could not get enough calories by enteral feeding to receive TPN either on ICU day 3, or to wait until ICU day 8. While waiting for their TPN in the late group, patients got calories in sugar [… read more]
Flexible pressure CPAP reduces pressure briefly during expiration, to try to make it more comfortable. Bakker & Marshall meta-analyzed 10 randomized trials in >500 patients testing flexible pressure vs standard CPAP in people with obstructive sleep apnea; there were no differences in compliance or any other outcome. CHEST 2011;139:1322-1330.
Schuchert et al looked back at 107 patients with stage IA subcentimeter non-small cell lung cancer, and found that 5-year survival was similar (~88%) for those undergoing wedge resection (n=35), segmentectomy (n=40), or lobectomy (n=32). Ann Thorac Surg 2011;91:1681-1688.
Zager et al examined registry data on 38,917 patients admitted to Beth Israel and Brigham & Women’s hospitals between 1997-2007, and concluded that low socioeconomic status (as determined by census tract neighborhood of residence) did not influence 30- or 365-day mortality after admission to these hospitals’ ICU. CHEST 2011;139:1368-1379.
Hargreave and Nair (PRO) argue the boutique technique is underrated and underused, citing trials showing improvement in severe asthma outcomes when sputum eosinophils are used to guide therapy (1, 2, and studies on IL-5 blockers). Peters (CON) questions the findings of those trials, doubts eosinophil count adds to clinical measures of asthma control, and compares [… read more]