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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]

Sep 282013
 
Intubation Checklists -- are theirs better than yours?

Intubation Checklists in the ICU and ED Can They Save Lives? Endotracheal intubation in the ICU or emergency department is often challenging, to understate by a lot. Intubations outside the operating room are often emergent rush jobs on crashing, hypotensive, severely hypoxemic patients, or people with who have just self-extubated. Pulmonologists’ and emergency physicians’ familiarity [... read more]

Sep 222013
 
E-cigarettes prove effective for smoking cessation

E-Cigarettes Shown Effective as Smoking Cessation Aids Electronic cigarettes or e-cigarettes use battery power to vaporize a solution, usually containing nicotine dissolved in propylene glycol, glycerin, or polyethylene glycol, creating a puff of “smoke” that dissipates harmlessly. E-cigarettes deliver a hit of nicotine (about 1/4 to 1/2 that of a cigarette puff), but their vapor [... read more]

Sep 132013
 
Vasopressors for septic shock (Surviving Sepsis Guidelines)

Vasopressors for Septic Shock (Surviving Sepsis Guidelines) See All the Surviving Sepsis Guidelines Vasopressors are provided for septic shock that does not respond to fluid resuscitation. Norepinephrine (Levophed), epinephrine, vasopressin, phenylephrine (Neo-Synephrine), and dopamine are the most commonly used vasopressors for septic shock. To achieve adequate fluid resuscitation, the Surviving Sepsis Guidelines advise at least 30 ml/kg [... read more]

Sep 132013
 
Mild weight gain after quitting smoking outweighed by cessation's benefits

Weight Gain After Quitting Smoking Usually Mild, Harmless Nicotine is an anorexigen, or appetite suppressant. This “benefit” of cigarette smoking is no secret, certainly not to teenage girls, who in surveys report smoking to stay thin. Even among women smokers over age 40, more than half said they would not quit smoking if it meant they would [... read more]

Sep 122013
 
Join Us at the 2013 Pittsburgh International Lung Conference

We are quickly approaching the 2013 Pittsburgh International Lung Conference on October 17-18, 2013. The theme, “Acute and Chronic Lung Infections: Novel Pathogens, Diagnostics, and Therapeutics aims to describe and discuss the latest clinical and research advances as they apply to respiratory infections by bringing together leading regional, national, and international experts in the field. [... read more]

Sep 052013
 

Following “Surviving Sepsis” Guidelines Not Always the Best Care By Dr. Philippe Rola First of all, I would like to commend those involved in the Surviving Sepsis Campaign’s Guidelines. It is a tremendous endeavour that, without a doubt, has heightened awareness and their growing implementation has and will save many lives. I would, however, also [... read more]