Mar 182018
Regular Aspirin Use May Slow COPD Progression

By Salynn Boyles, Contributing Writer, MedPage Today Regular aspirin use was associated with a more than 50% reduction in emphysema/chronic obstructive pulmonary disease (COPD) progression in an elderly cohort over a decade in a longitudinal analysis of data from a large lung study. The association was seen across aspirin doses, and was greatest in older study participants [… read more]

Mar 142018
FDA warns clarithromycin could cause death in patients with heart disease

The U.S. FDA is warning physicians against prescribing the antibiotic clarithromycin to patients with coronary artery disease. In long-term follow up of a randomized controlled trial, there was an unexpectedly higher rate of death in patients who received a two-week treatment course of clarithromycin, compared to placebo. FDA has added a new warning to clarithromycin’s [… read more]

Mar 122018
Is There Synergy between PEEP & Prone Position in ARDS?

Jon-Emile S. Kenny MD [@heart_lung] “… when you walk around a kitchen, you will say to yourself, this is interesting, this is grand, this is beautiful like Chardin.” -Marcel Proust Background Titration of positive end-expiratory pressure [PEEP] in the acute respiratory distress syndrome [ARDS] is achieved by a diverse assortment of practices undergirded by equally [… read more]

Mar 092018
At-Home Breath Training Improves Asthma Quality of Life

By Salynn Boyles, Contributing Writer, MedPageToday Self-taught breath retraining proved to be an effective, readily available and cost efficient strategy for improving quality of life among patients with asthma in a randomized trial. The training involved video instruction designed to teach patients breathing exercises such as diaphragmatic breathing, nasal breathing, slow breathing, controlled breath holds, and relaxation [… read more]

Mar 092018
Does Piperacillin-Tazobactam Cause Renal Failure?

The combination of the antibiotics piperacillin-tazobactam and vancomycin is so often used as empirical antibiotic coverage for severe infections in hospitalized patients that it’s been dubbed “Vosyn.” Vancomycin’s nephrotoxicity is well-known, requiring close monitoring of serum levels; pip-tazo has been seen to prolong increased creatinine levels (without significant known direct nephrotoxicity).  Reports have surfaced in [… read more]

Mar 082018
Hydrocortisone plus fludrocortisone improved survival from septic shock (APROCCHSS trial)

Patients with septic shock who received hydrocortisone and fludrocortisone together had improved survival compared to patients receiving placebo, according to a large randomized trial (APROCCHSS) published in the New England Journal of Medicine. From 2008-2015, investigators enrolled 1,241 patients in France with septic shock for less than 24 hours to receive either hydrocortisone 50 mg [… read more]

Mar 022018
Corticosteroids do help in sepsis: ADRENAL trial

Stress-dose corticosteroids appear safe and generally beneficial in patients with septic shock undergoing mechanical ventilation, without improving survival. That’s the takeaway from the ADRENAL trial recently published in the New England Journal of Medicine. Investigators (led by the famed ANZICS collaborative) randomized 3,800 patients with septic shock requiring mechanical ventilation in 69 medical-surgical ICUs around the [… read more]

Feb 222018
The Great Lactate Debate Part 2: can we ‘myth-bust’ the strong ion approach?

Jon-Emile S. Kenny MD [@heart_lung] “The truth is rarely pure and never simple.” -Oscar Wilde In part 1, the crux of this ‘Great Lactate Debate’ was distilled into the unclear origin of the proton in the setting of ‘lactic acidosis.’  Is the [H+] secondary to biochemical work and ATP hydrolysis or is the proton from [… read more]

Feb 192018
The Great Lactate Debate Part 1: should we be counting protons or strong ions?

Jon-Emile S. Kenny MD [@heart_lung] “….  She was here on earth to grasp the meaning of its wild enchantment and to call each thing by its right name …” -Boris Pasternak Background Over the last half-decade, there has been a distinct shift in the approach to lactate elevation.  The long-held belief that elevated serum lactate [… read more]

Feb 182018
Cardiovascular events were higher after starting a long-acting inhaler for COPD

People with chronic obstructive pulmonary disease (COPD) had an increased rate of heart attacks and strokes in the first month after starting long-acting inhaled bronchodilators. That’s the conclusion of an observational study from Taiwan, published in JAMA Internal Medicine. Researchers analyzed data on 284,220 Taiwanese adults with COPD who had never used bronchodilators, and were started on [… read more]

Feb 162018
Ruling Out PE in the ED: Critical Analysis of the PROPER Trial

By Scott Aberegg, M.D., M.P.H. This post is going to be an in-depth “journal club” style analysis of the PROPER trial. In this week’s JAMA, Freund et al report the results of the PROPER randomized controlled trial of the PERC (pulmonary embolism rule -out criteria) rule for safely excluding pulmonary embolism (PE) in the emergency department (ED) [… read more]

Feb 152018
PERC Can Safely Rule Out Pulmonary Embolism in ED Setting

By Salynn Boyles, Contributing Writer, MedPage Today A clinical assessment protocol proved to be as effective as blood testing and CT imaging in the emergency department setting for ruling out pulmonary embolism in very low-risk patients in a newly reported French clinical trial. The crossover cluster-randomized PROPER study was conducted at 14 emergency departments (EDs) in France [… read more]

Feb 142018
FDA Approves New Cystic Fibrosis Drug Combo

Vertex Pharmaceuticals won FDA approval for its third drug to treat cystic fibrosis, the company announced. Ivacaftor (Kalydeco) combined with tezacaftor, a new agent, will be sold as Symdeko. Symdeko was approved for patients age 12 or older who are homozygous for the F508 deletion of the CFTR gene, or who have another mutation that [… read more]

Feb 112018
Vasopressors and Inotropes for Shock Syndromes: Review

Overview Vasopressors and inotropes are cornerstones in the management of shock syndromes. Understanding vasopressors’ receptor activity and resultant pharmacological response enables clinicians to select the ideal vasopressor(s) for a patient suffering from shock. The following table outlines common vasopressors/inotropes and their general receptor activity profiles.1,2 Drug Dose α1 ß1 ß2 DA V1 V2 cAMP Norepinephrine [… read more]

Feb 062018
Meta-analysis: statins for COPD associated with better walk distance and quality of life

By Salynn Boyles, Contributing Writer, MedPage Today Treatment with statins may be beneficial in terms of improving exercise tolerance, pulmonary function and quality-of-life among chronic obstructive pulmonary disease (COPD) patients with co-existing cardiovascular disease, increased systemic inflammation or hyperlipidemia. That is the finding from meta-analysis of 10 randomized, controlled trials involving close to 1,500 patients, [… read more]

Jan 312018
Choose Wisely – Avoid Sildenafil for Pulmonary Hypertension in Corrected Left-Heart Valvular Disease (SIOVAC Trial)

Jon-Emile S. Kenny MD [@heart_lung] “It’s these expressions, I never give, That keep me searching for a heart of gold … And I’m gettin’ old.” -Neil Young An 86 year old woman is admitted with progressive dyspnea and lower extremity edema.  8 months ago she received a trans-catheter aortic valve replacement (TAVR) for severe aortic [… read more]

Jan 302018
Lung cancer screening with CT: Does it work in the real world?

The first real-world results from a population-based deployment of lung cancer screening are in, from a demonstration project at Veterans Affairs (VA) hospitals. Screening was generally effective at identifying early-stage lung cancer, but with far more effort per cancer detected than in the seminal National Lung Screening Trial. High false positive rates led to a [… read more]

Jan 292018
ICU Physiology in 1000 Words: Venous Doppler & Volume Tolerance

Jon-Emile S. Kenny MD [@heart_lung] With the birth of ‘fluid responsiveness’ physiology [1], there has been a slow and solemn drumbeat ushering the central venous pressure [CVP] up the squeaking planks of the hemodynamic gallows [2, 3].  Despite this, a few years ago I made a humble defense of the central venous pressure.  Importantly, I was [… read more]

Jan 262018
FDA Approves First Nebulized LAMA for COPD

by Salynn Boyles, MedPage Today The FDA approved a nebulized formulation of glycopyrrolate (Lonhala Magnair) for long-term maintenance treatment of patients with moderate-to-severe COPD, said manufacturer Sunovion Pharmaceuticals. It’s the first long-acting muscarinic antagonist (LAMA) to be sold in this form. Recommended dosing is 25 mcg twice daily. The approval was made on the strength of data [… read more]

Jan 232018
Conference: The Hospitalist & The Resuscitationist April 18-19

The Hospitalist & The Resuscitationist April 18-19, 2018 Two awesome days in Montreal where we focus on basics, but the right basics. The key points, the key pearls, and especially, the key physiological points in managing sick people. Day 1, pretty sick people. Day 2, really sick people. Do one day, do both, whatever fits [… read more]