Tranexamic acid has a small beneficial effect on hemorrhage from trauma or surgery. Among 270 subjects with intracranial hemorrhage due to trauma, those randomized to tranexamic acid showed a trend toward improved outcomes (mortality, hemorrhage extension, new bleeding foci) compared to placebo. Authors propose a large trial to explore further. BMJ 2011;343:d3795. FREE FULL TEXT
Update in Pulmonary Infections 2010. Wunderlink RG, Waterer GW. AJRCCM 2011;184:186-190.
Update in Mechanical Ventilation 2010. Richard J-CM et al. AJRCCM 2011;184:32-36.
Team science and critical care. Manthous CA, Hollingshead AB. AJRCCM 2011;184:17-25.
The Research Agenda in ICU Telemedicine: A Statement From the Critical Care Societies Collaborative. Kahn JM et al. CHEST 2011;140:230-238.
The new Xpert rapid MTB/RIF test is proving incredibly helpful in high-prevalence TB areas, esp. when HIV is also prevalent (i.e., Africa) and where delaying treatment for culture allows unchecked spread of TB. Sensitivity/specificity 95-99%, with a 55% sensitivity in smear-negative, culture-positive cases, report Theron et al. AJRCCM 2011;184:132-140.
Rapid response teams. Jones DA et al. NEJM 2011;365:139-146. FULL FREE TEXT
A retrospective review of 521 patients in one Virginia center from 2000-2009, by Nathan SD et al. CHEST 2011;140:221-229
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.
Lung transplantation. Kotloff RM, Thabut G. AJRCCM 2011;184:159-171.
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]
Diffuse idiopathic pulmonary neuroendocrine cell hyperplasia. Nassar AA et al. AJRCCM 2011;184:8-16.
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.