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Dec 112013
 
Management of obstructive sleep apnea: New guideline from ACP

The American College of Physicians released a new clinical practice guideline for the management of obstructive sleep apnea, published in Annals of Internal Medicine. ACP advises people with obstructive sleep apnea should use CPAP therapy or other airway opening devices such as mandibular advancement devices, and should be encouraged and assisted in losing weight. The guideline was [... read more]

Dec 082013
 
Ventilator-Induced Lung Injury Review (Part 2 of 2)

Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [... read more]

Dec 072013
 
Ventilator-Induced Lung Injury Review (Part 1 of 2)

Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, especially when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation can damage fragile alveoli already made vulnerable [... read more]

Dec 012013
 
Do colloids save lives in hypovolemic shock?

So, your patient’s in shock: quick, give some fluids. But colloids or crystalloids? How to choose? They both raise blood pressure, they both improve organ perfusion — but one’s less filling, the other tastes great (what, you haven’t tried them?). It’s no wonder the question makes your head hurt; the evidence base is a jumble. The [... read more]

Nov 282013
 
CPAP for sleep apnea improved drug-resistant hypertension

Most people with obstructive sleep apnea (OSA) have high blood pressure (hypertension), but treating OSA with continuous positive airway pressure (CPAP) has been shown to reduce blood pressure only minimally (by about 2.5 mm Hg). A randomized trial in the November 2013 Chest suggests that in people with severe drug-resistant hypertension with OSA, CPAP can [... read more]

Nov 232013
 
Hypothermia did not help after out-of-hospital cardiac arrest, in largest study yet

No Improvement in Cardiac Arrest Outcomes With Hypothermia Therapeutic hypothermia, or targeted temperature management, has become a standard component of post-cardiac arrest care. The evidence supporting this practice came from two small-to-medium-sized randomized trials, both published in the New England Journal of Medicine in 2002: Among 273 patients with out-of-hospital cardiac arrest due to shockable [... read more]

Nov 222013
 
Idiopathic pulmonary fibrosis linked to herpesvirus infection

Is Idiopathic Pulmonary Fibrosis Caused by a Virus? The cause(s) of idiopathic pulmonary fibrosis have vexed researchers for decades. Although risk factors (smoking, familial gene mutations) provide clues, the actual trigger for the proliferative, fibrotic cellular process resulting in usual interstitial pneumonitis (on biopsy specimens) and IPF (clinically) have remained frustratingly elusive. But an exciting [... read more]

Nov 162013
 
Shock Review: Mechanisms and Therapies

Shock Review (Part 1 of 2) (See also Shock Review Part 2: Goals of Therapy) Jean-Louis Vincent, editor in chief of Critical Care, has a new review article on circulatory shock in the New England Journal of Medicine, where he’s also the editor of their new critical care section. Daniel De Backer co-authors. (See also [... read more]

Nov 162013
 
Shock Review: Goals of Therapy

Shock Review (Part 2 of 2) (See also Shock Review Part 1: Mechanisms and Therapies) Shock results from serious illness compromising either vascular muscle tone (most commonly septic shock), the heart’s function, or the volume of plasma inside blood vessels. The true goal of treatment for shock is to correct the underlying cause, but except [... read more]

Nov 082013
 
Statins don't help in ventilator-associated pneumonia treatment

Statins have anti-inflammatory and immune-modulating effects, and among critically ill patients, continuing or starting statins have improved soft outcomes in observational and small randomized studies. For example, starting a statin reduced progression of sepsis in ward patients and statins improved organ failure scores in acute lung injury (the HARP trial). But in their first shot at [... read more]

Nov 082013
 
"CPAP cures metabolic syndrome" paper in NEJM: retracted!

In early 2012, PulmCCM breathlessly reported the results of a New England Journal of Medicine (NEJM) paper by Surenda K. Sharma et al, claiming to show that continuous positive airway pressure (CPAP) can reverse metabolic syndrome (obesity, dyslipidemia, and insulin resistance). Whoops. The authors retracted the article after keen-eyed academics smelled something fishy and asked [... read more]

Nov 062013
 
Breath tests can accurately diagnose lung cancer

Diagnosing lung cancer without a biopsy may seem like science fiction, but breath testing to identify lung cancer has made steady gains in accuracy in recent years. A study abstract presented by Peter Mazzone et al at Chest 2013 in Chicago shows just how far one of the new technologies — volatile organic compound analysis [... read more]

Nov 062013
 
Olodaterol, a new once-daily LABA, proven effective for COPD

Olodaterol Olodaterol, a new once-daily inhaled long-acting beta agonist, improved lung function and exercise capacity in chronic obstructive pulmonary disease (COPD) in two randomized trials (n=199) presented by Gregory Feldman et al at the Chest 2013 meeting in Chicago. The new once-daily LABA olodaterol will reportedly be marketed by Boehringer Ingelheim under the trade name Striverdi [... read more]

Oct 312013
 
Breo Ellipta (vilanterol/fluticasone) matches Advair in RCT

Breo Ellipta (GlaxoSmithKline) is the first FDA-approved combination product with a once-daily long acting beta agonist (vilanterol) and inhaled corticosteroid (fluticasone). Additional once daily combination ICS/LABA and LABA/antimuscarinics are expected to launch over the next decade, increasing the options for treatment of asthma and COPD. GSK got good news in the October Chest, with the publication [... read more]

Oct 312013
 
Indacaterol vs Tiotropium: Tie on FEV1; Spiriva wins on exacerbations

Once-daily long-acting beta agonist indacaterol (Arcapta Neohaler) went head to head against tiotropium (Spiriva) in a randomized trial among 3,444 patients with severe COPD, funded by indacaterol makers Novartis. Indacaterol, approved in 2011 as a treatment for COPD, was deemed noninferior to tiotropium according to the prespecified criteria of the trial, bronchodilating almost identically (a [... read more]

Oct 302013
 
"Choosing Wisely" campaign targets pulmonary hypertension drugs' off-label use

Choosing Wisely, the initiative for medical cost-effectiveness (don’t call it rationing!) of the American Board of Internal Medicine, included the use of vasodilators for pulmonary hypertension owing to left heart disease or hypoxemic lung disease (WHO Groups II and III) as #2 on its top five “no-no’s” in its new pulmonology section. The “Five Things Physicians and [... read more]

Oct 292013
 
Esmolol infusion reduced septic shock mortality by 40% in RCT

Do I.V. Beta-Blockers Save Lives in Septic Shock? Catecholamines can be toxic — just ask anyone experiencing the heartbreak of tako-tsubo syndrome. Blocking the heart-flogging effects of the hormones epinephrine (adrenaline) and norepinephrine have long been known to improve long-term survival in congestive heart failure. People with septic shock might be the last group you’d consider giving [... read more]

Oct 242013
 
Dysphagia and swallowing disorders in the ICU (Review)

ICU-related Dysphagia and Swallowing Disorders More than 700,000 people develop respiratory failure requiring mechanical ventilation each year in the U.S. alone, and those that survive are at elevated risk for developing swallowing dysfunction. The aspiration syndromes that follow can be devastating, especially if not recognized and addressed early. Denver’s Madison Macht et al provide a clinical [... read more]

Oct 232013
 
Dupilumab reduced asthma exacerbations by ~90% in RCT

Dupilumab, an injectable monoclonal antibody that inhibits signaling by interleukin-4 and interleukin-13, reduced asthma exacerbations by almost 90% while also improving asthma symptoms in a randomized trial. Participants had moderate-to-severe asthma that had previously been uncontrolled despite use of inhaled corticosteroids with long-acting beta-agonists. Twenty five million people in the U.S. — 8% of the population [... read more]