PulmCCM - Page 30 of 41 - All the best in pulmonary & critical care
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Jul 032011
 

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]

Jul 022011
 

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.

Jul 022011
 

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]

Jun 262011
 

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]

Jun 262011
 

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.

Jun 252011
 

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.

Jun 252011
 

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]

Jun 222011
 

New York’s city council banned smoking in almost all public spaces on May 23. Colgrove et al raise the interesting point that because the risk from secondhand smoke outdoors is nil, the political move oversteps the mandate of public health, and is instead heavyhanded social engineering that will further stigmatize smokers, a sad and addicted [… read more]