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]
Looking retrospectively at 2,399 ICU patients with preadmission vitamin D measurements on file, those with vitamin D deficiency had an odds ratio of ~1.7 for 30, 90, and 365-day mortality after ICU admission, after multivariate analysis. Braun et al, Crit Care Med 2011;39:671-677.
Dabigatran, a new oral thrombin inhibitor : Hankey GJ, Circulation 2011;123:1436-1450.
20% of U.S. deaths now occur during or soon after an ICU stay — but the families live on, often with upsetting memories, depression, and anxiety. Kross et al re-heat data from the IPACC palliative care study in Washington, surveying family members of ICU decedents, showing they had a 14% prevalence of PTSD symptoms and 18% of [… read more]
Delirium in the ICU, management of: Schiemann A, Curr Opin Crit Care 2011;17:131-140.
A systematic review of 3 trials (n=337) by the Bed Head Elevation Study Group (not to be confused with the Bedhead photo group) found no good evidence that head-of-bed (HOB) elevation to 45′ helps or harms in any way (pneumonia, decubiti, mortality, VTE, or hemodynamic instability). Nevertheless, a consensus panel of 22 experts agrees with previous [… read more]
Interferon-gamma release assays in the diagnosis of latent tuberculosis infection: Herrera V, Clin Infect Dis 2011;52:1031-1037.
The MTB/RIF test is a rapid nucleic acid amplification test for TB. In a rollout in developing countries on 6,648 patients, the test was 90% sensitive for active TB, vs. 67% for smear microscopy (sputum culture was the gold standard). In smear-negative, culture-positive TB, the test was 77% sensitive and 99% specific. It also accurately detects rifampin [… read more]