Sleep medicine training across the spectrum, Strohl KP, CHEST 2011;139:1221-1231. Sleep review.
In a review of the charts of 3,138 patients who died in 15 ICUs, Muni et al report that the 21% nonwhite patients (incl. 9% Asians, 7% blacks, 3% Hispanics) had odds ratios of 0.41 for having a living will; 1.59 for having full life support at the time of death; 1.57 for having a physician recommend [… read more]
Clinical research is hamstrung by slow, labor-intensive data collection, necessitated by disparate technologies (or lack of them) in the ICU. Saeed et al announce MIMIC II, a free, public access database that includes nearly all the relevant data from 25,328 ICU stays at Beth Israel 2001-2007 (including hourly vital signs, all labs, and some ECG waveforms). The quantum leap here [… read more]
Year in Review 2010 in pulmonary & critical care: Heuser et al, Arch Int Med 2011;154:614-621.
Never-smokers make up >25% of the people with COPD in some studies. Who are these people? The BOLD study gathered data from 14 countries (in the U.S., Europe, Turkey, China, South Africa, Philippines and Australia), including spirometry and questionnaires on environmental exposures and symptoms from 10,000 people. Of the 4,291 never-smokers, 4% had ATS-defined COPD (5.6% by [… read more]
Iyer et al re-checked PFTs on 1,284 people with nonspecific results (low FEV1 or FVC but normal TLC and FEV1/FVC ratio), at a median of 3 years after the abnormal test. 64% continued to have the nonspecific result; 16% had restriction; 15% had obstruction; 2% had a mixed pattern; 3% were normal. They recommend changing [… read more]
Patients taking pramipexole for 6 months had a 14-point fall in their IRLS score, and 59% “responded” (had at least a 50% fall in their score). But time worked well, too: placebo patients had an 11-point decline in scores and 43% responded. So 1 in 6 responded to pramipexole, practically speaking (they don’t say this, [… read more]
Pulmonary hypertension is often “diagnosed” with a tricuspid regurgitant jet velocity > 2.5 m/s on echocardiogram. Bossone et al found that 76 of 615 (12%) trained athletes (strength or endurance) exceeded this number, and suggest the upper limit of normal should be 40 mm Hg in endurance athletes. CHEST 2011;139:788-794.
Four-drug therapy (RIPE) requires high patient commitment and imposes logistical demands on health systems in developing countries. Lienhardt et al report that a fixed-drug combination (FDC) of rifampin, isoniazid, pyrazinamide, and ethambutol was noninferior in producing negative cultures at 18 months compared to taking the drugs separately (both arms ~94% cure rate) in Africa, Asia and Latin [… read more]
Fen-phen died in court, but phenteramine was cleared of all serious charges. Gadde et al report phase III results for Qnexa (by Vivus), a phenteramine-topiramate combination. Over 56 weeks, takers of a double-dose of study drug lost 10 kg; single-dose, 8 kg; and placebo, 1.4 kg. There were plenty of side effects (dry mouth and paresthesias [… read more]
Sacanella et al prospectively observed 230 generally healthy, cognitively intact, highly functional & independently living Spaniards 65 years or older (mean age 75) after urgent admission to a single MICU. About half received mechanical ventilation (54%). Seventy died in-hospital; 48 died within a year, for a one-year survival of 49%. But among the 112 survivors, [… read more]
Acute liver failure: Larsen FS, Curr Opin Crit Care 2011;17:160-164. Fulminant hepatic failure review.
Maki et al randomized 407 patients at 25 dialysis units to have their catheters “locked” for up to 6 months with either heparin, or “C-MB-P solution” (citric acid, methylene blue, and propylparaben). The patients getting the antimicrobial potion had a 0.29 relative risk for bloodstream infection (BSI) without loss of catheter patency. (n=407) Crit Care Med 2011;39:613-620.
In a 5-week prospective observational study in 47 Australian & New Zealand ICUs, Pettila et al (the ANZICS group) followed 757 ICU patients receiving red blood cell transfusions for anemia of any cause. Those in the quartile receiving the youngest RBCs (mean age 7.7 days) had an absolute 8% lower mortality than the other 3 [… read more]
Acute-on-chronic liver failure, concept, natural history, prognosis: Olson JC, Curr Opin Crit Care 2011;17:165-169. Hepatic failure review.
Varenicline is to be started one week prior to the smoking cessation quit date. Hajek et al randomized patients to take Chantix or placebo as a run-in for 3 weeks prior to that. All patients took varenicline for 1 week prior and 3 months after quitting. Those who were “preloaded” had 12-week abstinence rates of [… read more]
Stanworth et al previously showed that 30% of ICU patients have prothrombin time prolongation at some point. Here, they examined FFP transfusion In an 8-week-long prospective observational study in 29 ICUs in the UK. Fully 31% of FFP units were given to patients with INR < 1.5. About half the FFP units went to patients [… read more]
Interviewing 100 patients or their surrogates in the ICU, 85% of whom were “full code,” Gehlbach et al found 16% of patients’ code status in the chart did not correlate with their expressed preferences during the interview (10 wanted less care, 6 wanted more). Respondents’ average prediction for their survival should they have a cardiac [… read more]
Cryptogenic and secondary organizing pneumonia: Drakopanagiotakis F et al, CHEST 2011;139:893-900. COP and BOOP review.
Gooneratne et al selected 289 people over 65 (nondemented, nondepressed), half of whom had excessive daytime sleepiness (EDS). All got polysomnograms and were followed for a mean of 14 years. Those with EDS and sleep disordered breathing (SDB) had a hazard ratio for mortality of 2.7, that fell to 2.3 after adjusting for covariates. People [… read more]