Using PCR testing on BAL fluid, Denning et al (in Manchester UK) found Aspergillus DNA in 4 of 11 (36%) healthy volunteers; 21 of 22 patients with culture/microscopy-proven invasive aspergillosis; and 70-80% of patients with allergic bronchopulmonary aspergillosis or chronic pulmonary aspergillosis. Culture was positive in none of the ABPA patients, and only 17% of the CPA [… read more]
Parra et al diagnosed OSA in 140 patients hospitalized for stroke in Spain and randomized them to nasal auto-titrating CPAP or no therapy. The CPAP-treated patients had better Rankin and Canadian stroke outcome scores at all follow-up visits. They had the same rate of subsequent cardiovascular events, but events occurred at a median 15 months [… read more]
Lung cancer diagnosis and treatment: summary of updated NICE guidance. Baldwin DR et al, BMJ 2011;342:d2110. Lung cancer review.
In a community-based sample of 3,802 Spaniards aged 40-80, 4.6% had FEV1/FVC <0.7 but above the lower limit of normal. Mostly older men, they had the same respiratory exacerbation frequency, activity levels, cardiovascular risk, and 6-minute walk distances as matched controls with a ratio >0.7. They did report lower health-related quality of life in all [… read more]
De Smet et al reheat the data from their 2009 NEJM study, in which they cluster-randomized and crossed-over 5,939 patients staying >48hrs in 13 Dutch ICUs to receive either 1) standard care; 2) selective oropharyngeal decontamination (topical amphotericin B, colistin, and tobramycin in the oropharynx), or 3) selective digestive tract decontamination (the same drugs in the mouth, stomach, [… read more]
Nocturnal monitoring of home non-invasive ventilation: Janssens JP, Thorax 2011;66:438-445. Sleep and obesity hypoventilation review.
Rich et al from U. of Chicago add to the “we said, they said” record on echocardiography’s accuracy in measuring PA pressures (and by implication, whether it can be used to justify oral therapy for PAH without invasive testing). They measured 160 people’s PAP by right heart catheterization and ECHO, both tests within one month; they then [… read more]
Non-CPAP therapies in obstructive sleep apnea, European Respiratory Society task force statement. ERJ 2011;37:1000-1028. Sleep review, OSA review.
CF patients are instructed to inhale dornase alpha 30 minutes before airway clearance techniques. This has always been based on lore and plausibility. Dentice & Elkins publish their meta-analysis of 5 studies, including a total of 122 patients who were randomized and crossed-over to test the effect of the timing of dornase inhalation on outcomes. [… read more]
Rubboli et al summarize the (weak) evidence and current guidelines. General avoidance of drug-eluting stents in those with need of long-term warfarin is still the party-line recommendation, with triple therapy (warfarin, aspirin, clopidogrel) for those who receive a DES due to a strong indication. While TT is clearly superior for high risk patients (e.g., mechanical valve), the [… read more]
Pseudomonas pneumonia part II, antibiotic therapy, resistance, pharmacodynamics, Sun H et al, CHEST 2011;139:1172-1185. Review.
As part of their landmark Keystone MHA project in Michigan ICUs (that previously demonstrated a 0% catheter-related bloodstream infection rate with adherence to a central-line bundle), Sexton, Pronovost et al also implemented the CUSP intervention to create a climate of continuous quality improvement and safety. Based on surveys of the staff in 71 ICUs, mean safety scores rose from 42.5% in 2004 to [… read more]
Osteopontin is a cytokine; Lorenzen et al measured levels in 95 people with idiopathic pulmonary arterial hypertension, 25 of whom were followed prospectively for 3 months after therapy initiation. Elevated osteopontin was more common in people with IPAH than in healthy controls, predicted mortality, and correlated with 6-minute-walk distance and NYHA class in the retrospective cohort. CHEST 2011;139:1010-1017.
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]