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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]

Oct 222013
 

A large phase III randomized trial testing Ambrisentan (Letairis) for early idiopathic pulmonary fibrosis was stopped early after an interim analysis of the data showed possible harm. The results were reported in Annals of Internal Medicine. Patients being treated with Letairis had more evidence of progression of idiopathic pulmonary fibrosis and were hospitalized more often, including [... read more]

Oct 222013
 

Ultrasound-guided central venous catheter insertion: Standard of care, or preventing procedural skills? By Dr. Philippe Rola Ok, so let me preface this with the fact that I walk around with a handheld ultrasound rather than a stethoscope, and that I examine ALL patients with a focused cardiopulmonary and abdominal exam. My bias towards bedside ultrasound is [... read more]

Oct 192013
 
Overnight intensivists unnecessary in well-staffed ICUs? (Meta-analysis)

24/7 Intensivist Coverage Does Not Improve Outcomes: Meta-Analysis The debate over whether ICUs should be staffed around the clock by intensivist physicians has simmered for more than 20 years, with opinions on both sides driven more by values and personal biases than evidence. Recent studies have confirmed the benefit of daytime intensivists in ICUs but failed [... read more]

Oct 182013
 
Riociguat (Adempas) approved for PAH and CTEPH (pulmonary hypertension)

Riociguat (Adempas) Gets FDA Indications for Pulmonary Hypertension That was fast. The US Food and Drug Administration (FDA) approved riociguat (brand name Adempas, by Bayer) for the treatment of pulmonary arterial hypertension (PAH) and the treatment of chronic thromboembolic pulmonary hypertension (CTEPH), on October 8 2013. Adempas is the first of a class of drugs for pulmonary hypertension [... read more]

Oct 172013
 
Home testing for sleep apnea bankrupting U.S. sleep centers

Home Sleep Apnea Testing: New Standard is Bad Deal for Sleep Docs Sleep doctors in the U.S. have been doubling up on their Prilosec and putting their accountants on speed-dial since the federal government and insurers began signaling they plan to eventually run the $2,000-per-sleep-study gravy train off its rails. With an estimated 18 million people [... read more]

Oct 162013
 
Spiriva Respimat inhaler as safe as HandiHaler (TIOSPIR)

Tiotropium: Safe In Either Form Tiotropium (Spiriva) comes in two devices: the Respimat in Europe delivers a mist, while the Handihaler in the U.S. delivers a dry powder. The Respimat has been bronchodilating under a dark cloud in Europe for the past 2 years, since a BMJ meta-analysis suggested there was a 52% increased risk of [... read more]

Oct 062013
 
Mechanical ventilation in ARDS due to sepsis (Surviving Sepsis Guidelines)

Mechanical Ventilation in ARDS Due to Sepsis See All the Surviving Sepsis Guidelines Sepsis is one of the main causes of acute respiratory distress syndrome (ARDS), in which the lungs are injured by circulating inflammatory mediators, resulting in severely impaired gas exchange usually requiring invasive mechanical ventilation. ARDS also results in poor lung compliance in [... read more]

Oct 062013
 
Pulmonary rehabilitation: no benefit at one year, even with extended Rx? (Review)

Pulmonary Rehabilitation: No Benefit After 12 Months Light, Infrequent Workouts Don’t Sustain Fitness Gains Pulmonary rehabilitation (“pulmonary rehab”) is a dressed-up name for what are essentially supervised exercise programs for people living with chronic lung disease. Although pulmonary rehab programs often include multidimensional support (nutrition, education, breathing exercises and psychological counseling), it’s the exercise that produces [... read more]

Sep 292013
 
Blood products for sepsis and septic shock (Surviving Sepsis Guidelines)

Transfusion of Blood Products for Sepsis and Septic Shock See all the Surviving Sepsis Guidelines People with severe sepsis and septic shock frequently experience what could be termed “hematologic failure” — abnormalities of blood cell lines and clotting / antithrombotic proteins that can occur in complex, protean patterns. Anemia, thrombocytopenia, leukopenia, disseminated intravascular coagulation, and [... read more]