Mar 112011
 

Roquilly et ses amis francais randomized 150 critically ill victims of severe French trauma to hydrocortisone or placebo for 7 days. The treated group had an absolute 16-19% lower risk for hospital-acquired pneumonia, the primary endpoint (36% vs. 51-54% depending on which intention-to-treat analysis you prefer, p=0.007 to 0.01). (n=150). JAMA 2011;305:1201-1209.

Mar 102011
 

Fernandez-Cerrano et al randomized 56 people with CAP in Spain (only 3 needed mechanical ventilation) to receive methylprednisolone bolus-and-taper or placebo, in addition to ceftriaxone and levofloxacin. The steroid-treated group had less hypoxemia (lower PaO2/FiO2). (n=56). Critical Care 2011;15:R96. FREE FULL TEXT MORE ON THIS: In AJRCCM 2005, Confalonieri found less septic shock and need [… read more]

Mar 092011
 

Accurso et al report phase 3 results from industry-funded TIGER-1, testing t.i.d. inhaled denufusol (an ion channel regulator that alters sodium/chloride transport to improve mucociliary clearance) vs. placebo in early cystic fibrosis (FEV1>74% predicted). After 24 weeks, FEV1 was 45 mL better in the treated group, most of whom were younger than age 19. There [… read more]

Mar 082011
 

Warfarin is the best drug for stroke prevention in atrial fibrillation. In people with a-fib for whom warfarin was unsuitable (unstable INR, unlikely adherence, etc, but excluding those with prior bleeding on warfarin), twice daily oral direct Xa inhibitor apixaban had a hazard ratio of 0.45 over aspirin for the primary outcome of stroke (absolute [… read more]

Mar 032011
 

Radiation risks from imaging; pharmacy and lactation; critical illness; interventional chest procedures; asthma; smoking; cystic fibrosis; pneumonia; infiltrative lung diseases; pulmonary embolism; pulmonary hypertension, and sleep-disordered breathing in pregnancy. Coming in just under 200 pages. Clinics in Chest Medicine 2011;32:1-198.

Mar 022011
 

In a rare encouraging positive study in the chronically critically ill, 71% of vent-dependent patients (~6 weeks on MV) who did multiple sets of daily inspirations backwards through a PEEP valve weaned from mechanical ventilation (defined as >72 hrs off the vent), vs. 47% receiving a sham treatment. MIP also improved by 10 cmH2O in [… read more]