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Sep 022013
 
Surviving Sepsis Guidelines: Early Goal Directed Therapy, Initial Fluid Resuscitation

Initial Volume Resuscitation and EGDT for Severe Sepsis/Septic Shock See all the Surviving Sepsis Guidelines An approach including early goal directed therapy with aggressive initial fluid resuscitation has been considered a cornerstone of initial therapy for severe sepsis and septic shock, since a single-center randomized trial showed such a strategy initiated in the emergency department [... read more]

Sep 022013
 
Surviving Sepsis Guidelines: Initial Antibiotic / Antimicrobial Therapy

Initial Antibiotic / Antimicrobial Therapy in Severe Sepsis/Septic Shock For Sepsis, Use the Right Antibiotics at the Right Time (= As Early As Possible) See all the Surviving Sepsis Guidelines  The short version: Give appropriate and effective antibiotics as early as possible for patients known or suspected to be in severe sepsis or septic shock. [... read more]

Aug 242013
 
How to diagnose asthma (Review)

Diagnosis of Asthma: Review & Update Asthma is a poorly understood disease characterized by chronic inflammation of the airways (bronchi and bronchioles). This inflammation causes periodic constriction of the airways in people with asthma, with shortness of breath, wheezing, and coughing that is often worse at night or early in the morning. Asthma is thought [... read more]

Aug 242013
 
More children to be considered for adult lung transplants

More Children Under 12 to Be Considered for Adult Lung Transplants The Organ Procurement and Transplantation Network (OPTN), which is responsible for the life-and-death policies for allocation of lung transplants and other organs, announced it will allow children needing lung transplants to file expedited appeals to be listed for adult lungs. Children under 12 with [... read more]

Aug 162013
 
Vasopressin, steroids, epinephrine cocktail improved cardiac arrest outcomes

Adding Vasopressin, Steroids to Epinephrine Improved Cardiac Arrest Outcomes Contrary to what watching TV or even reading the newspaper will lead one to believe, outcomes after in-hospital cardiac arrest are very poor. Only about 1 in 5 survive to leave the hospital after cardiac arrest, and most survivors suffer significant cognitive impairment; up to half suffer [... read more]

Aug 162013
 
How to manage lung cancer when resection is high risk

Management of Lung Cancer in High Surgical Risk Patients By Blair Westerly, MD We all hope that surgical resection is an option for our unfortunate patients diagnosed with lung cancer.  However, as a consequence of the epidemiology of stage I non-small cell lung cancer, the standard of care, lobectomy with systematic mediastinal lymph node evaluation, [... read more]

Aug 112013
 
Low tidal volume ventilation reduces complications from abdominal surgery

Low Tidal Volume Ventilation Improves Outcomes in Elective Surgery Using low tidal volumes (6-8 mL/kg ideal body weight, or about 500 mL in the average man) during mechanical ventilation has been known for more than a decade to be lifesaving for people with acute respiratory distress syndrome (ARDS). Since reducing mortality by a relative 22% [... read more]

Aug 112013
 
USPSTF Recommends Lung Cancer Screening CT; Obamacare Pays

USPSTF Endorses Lung Cancer Screening CT; New Standard of Care Begins Lung cancer screening CT took its most important step toward widespread implementation last week, when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meeting entry criteria for the National Lung Screening Trial [... read more]

Aug 032013
 
Oral N-acetylcysteine (NAC) reduces COPD exacerbations in RCT

image: Vitacost N-acetylcysteine (NAC) Improves COPD Outcomes Oxidative stress (imbalance between oxidants and antioxidants) is part of the story of how COPD causes symptoms of cough and shortness of breath. Cigarette smoke is the main source of oxidation damage in the lungs leading to COPD, but even after they quit smoking, people with COPD still [... read more]

Aug 032013
 
Riociguat for Pulmonary Hypertension: New Kid on the Block

New Pulmonary Hypertension Drug Riociguat Proves Effective Pulmonary arterial hypertension is a rare but life-threatening illness affecting around 10,000 people in the U.S., in which ongoing remodeling of the pulmonary vasculature leads to narrowed pulmonary arteries with increased pulmonary artery pressure (pulmonary hypertension), and if untreated, eventual right heart failure and death. (The overwhelming majority [... read more]

Aug 032013
 
Riociguat improves chronic thromboembolic pulmonary hypertension (CTEPH)

Riociguat Improves Chronic Thromboembolic Pulmonary Hypertension (CTEPH): CHEST-1 Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of pulmonary embolism, in which the pulmonary blood vessels become occluded by the body’s ongoing reaction to residual blood clots. The result is slowly worsening shortness of breath, pulmonary hypertension, and eventually right heart failure. People with chronic [... read more]

Jul 272013
 
How to ration lung cancer screening CTs, rationally

Restrict Lung Cancer Screening CT To Highest-Risk People? The National Lung Screening Trial showed that 3 annual low-dose chest CT scans in people with heavy smoking histories (30+ pack-years) saved lives, reducing the risk of death from lung cancer by a relative 20% compared to screening with annual chest X-rays. With 160,000 lung cancer deaths [... read more]

Jul 272013
 
Diagnosing and managing obstructive sleep apnea, before and after surgery (Review)

Obstructive Sleep Apnea and Perioperative Complications: A Review Obstructive sleep apnea and other sleep disorders may affect as many as 70 million U.S. adults — 1 in 4 men and 1 in 10 women. People with obstructive sleep apnea are usually obese, have other medical conditions, and are more likely to undergo surgery than people [... read more]

Jul 192013
 
Intensivists overnight in the ICU don't help, if you're already good

Nighttime Intensivist Staffing Does Not Help (Again) As I’ve said before, probably past the point of being annoying, we intensivists perform a vital service for humanity — just ask us. Numerous studies have concluded that a specialized intensivist’s presence in an intensive care unit during the day saves lives and results in better use of health [... read more]

Jul 182013
 
Biomarkers help predict COPD exacerbations

Biomarkers Predict COPD Exacerbations (Sort Of) In addition to daily breathlessness, people with chronic obstructive pulmonary disease (COPD) often experience exacerbations of shortness of breath and coughing. Those with more severe COPD tend to have more frequent and severe exacerbations, lower enjoyment of life, and more rapid loss of lung function. The strongest predictor of [... read more]

Jul 112013
 
Early parenteral nutrition does not improve survival

Early Parenteral Nutrition (TPN) Didn’t Save Lives Under the high stress of critical illness, people lose fat and muscle quickly. Obesity appears to be protective during critical illness, possibly because those extra fat reserves come in handy during this period of accelerated catabolism. The strong physiological rationale and the psychological pressure not to appear to be [... read more]

Jul 102013
 
EUS / EBUS beat transbronchial biopsies for diagnosis of sarcoidosis in RCT

image: Olympus EUS / EBUS Superior at Diagnosing Sarcoidosis This post has been edited from the original to reflect a correction. It originally reported that this trial suggested EBUS alone was superior to transbronchial biopsy; see below. Sarcoidosis affects tens of thousands of people in the U.S., but making the diagnosis can be tricky. A [... read more]

Jul 052013
 
In COPD exacerbations, 5 days steroids seem as good as 14 (REDUCE trial)

For COPD Exacerbations, 5 Days Corticosteroids As Good as 2+ Weeks COPD exacerbations — worsening of shortness of breath and cough, often requiring medical treatment — are a major problem for many people living with COPD. People with moderate or severe emphysema and chronic bronchitis (together called chronic obstructive pulmonary disease) experience an average of [... read more]

Jul 042013
 
Many people with metastatic lung cancer think radiation can cure

image: cancer.gov Patients With Metastatic Lung Cancer Often Believe Radiation Could Cure Among 384 patients with metastatic lung cancer who answered a survey, two in five expressed belief that radiation therapy was “very likely” or “somewhat likely” to cure them. Eighty percent thought radiation therapy would allow them to live longer, and only one-third admitted [... read more]

Jun 272013
 
Early tracheostomy does not improve survival or other outcomes (TracMan trial)

image: CUHK Early Tracheostomy Does Not Help in Large “TracMan” Trial More than 100,000 tracheostomies are performed worldwide each year for people requiring prolonged periods of mechanical ventilation. It’s generally agreed that to avoid damaging the trachea and throat, a tracheostomy should be placed within 3 weeks of mechanical ventilation. But prior to 3 weeks, [... read more]