Sep 172018
 

by Salynn Boyles, MedPage Today Contributing Writer Treatment with the first approved once-daily, single inhaler triple therapy for COPD resulted in a significantly lower rate of exacerbations, as well as better lung function and quality of life compared to dual therapy in patients with a history of exacerbations, researchers reported. Results from the huge IMPACT trial supported an [… read more]

Sep 132018
 
ECMO fails as first-line treatment for ARDS. Or did it?

Extracorporeal membrane oxygenation (ECMO) is an accepted salvage therapy for severe acute respiratory distress syndrome (ARDS) after conventional mechanical ventilation with low tidal volumes, neuromuscular blockade and prone positioning have failed. ECMO has been proposed as the ultimate lung protection strategy for ARDS, because it bypasses the lungs entirely. So why shouldn’t it be first-line [… read more]

Sep 132018
 
New MRI technology could predict outcome after cardiac arrest

Brain damage with severe cognitive and functional impairment are common after cardiac arrest, but far from universal. Even after thorough testing, most comatose patients receive an indeterminate neurologic prognosis post-arrest. Physicians faced with this uncertainty have a difficult task in counseling family members trying to make decisions to maximize their loved one’s chances for recovery [… read more]

Sep 082018
 
High Flow Oxygen in Chronic Obstructive Pulmonary Disease: improved work of breathing or respiratory effort?

Jon-Emile S. Kenny MD [@heart_lung] “WANTED: Somebody to go back in time with me.  This is not a joke …” -John Silveira Case A 78 year old man with known moderate-to-severe emphysema is extubated in the ICU; he was initially admitted with hypercapneic respiratory failure secondary to influenza pneumonia and pulmonary edema from the medical [… read more]

Sep 052018
 
Subsegmental pulmonary embolism: anticoagulation or observation?

As the use of chest CT-angiograms in emergency departments and medical wards has risen by more than tenfold, so has the discovery of small pulmonary emboli of unclear clinical significance. These PEs are often isolated to distal (subsegmental) branches of the pulmonary artery, without concurrent deep venous thrombosis (DVT). Small distal PEs may be incidentally [… read more]

Aug 282018
 
Simvastatin & Hyper-inflammatory ARDS: re-analysis of the HARP-2 trial

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD “For others, in spite of myself, from myself.” -Emmanuel Levinas Case A 52 year old man is admitted to the intensive care unit with bilateral pulmonary opacities, worsening gas-exchange and hypotension requiring peripherally-administered norepinephrine.  His PaO2-to-FiO2 ratio is less than 100; he is [… read more]

Aug 192018
 
Seven days of antibiotics were as good as 14 for gram-negative bacteremia

Two-week antibiotic courses have been considered standard care for most patients with bacteremia who do not have sepsis or an untreated primary source (e.g. endocarditis). No good evidence ever supported the practice, which was supported mainly by retrospective data in patients with sepsis. A new study suggests that treating gram-negative bacteremia for seven days is [… read more]

Aug 192018
 
Aspirin Appears Protective in COPD Patients

by Ed Susman, Contributing Writer, MedPage Today SAN DIEGO – Patients diagnosed with chronic obstructive pulmonary disease (COPD) who are also on aspirin therapy appear to have a lower rate of COPD exacerbations, researchers reported at the annual conference of the American Thoracic Society. The risk of experiencing any acute exacerbation of COPD was reduced by 18% among [… read more]

Aug 162018
 
Extended antibiotic infusions could save lives: Here's how to do it

By Thomas C. Neal, PharmD According to a meta-analysis of randomized trials, prolonged infusions of antipseudomonal beta-lactam antibiotics could save lives. However, obstacles to implementing pharmacodynamically optimized administration practices have slowed the adoption of this practice in most ICUs:1 The requirement for IV pumps, preferably smart IV pumps, is potentially problematic in resource-limited settings or on wards [… read more]

Aug 122018
 
Asthma patients should use ICS-LABA for rescue as well as maintenance, SMART says

In Europe, patients with asthma have long been advised to take more puffs of their combination inhaled corticosteroid-long-acting beta-agonist (ICS-LABA) inhaler during periods of increased asthma symptoms. In the U.S., patients are instead advised to use albuterol as their rescue inhaler, and stick firmly to the usual maintenance dose of ICS-LABA regardless of symptom severity. [… read more]

Aug 122018
 
Increasing inhaled steroids to abort asthma attacks: does it work?

When patients with asthma feel their symptoms worsening and fear a full-blown exacerbation is imminent, what should they do? Doctors and researchers have never found a good answer to this question for most patients. The options are, generally: 1) continue current controller inhalers and observing; 2) increase the dose of inhaled steroid inhalers; or 3) [… read more]

Aug 072018
 
In-Flight Medical Events & Emergencies: part 2

Jon-Emile S. Kenny MD [@heart_lung] “I’m learnin’ to fly … but I ain’t got wings … comin’ down … is the hardest thing.” -Tom Petty Common Events Continued … Abdominal Pain Like chest pain, abdominal pain carries a wide differential diagnosis.  Abdominal pain comprises 4% of all in-flight events and 10% of all diversions.  An [… read more]

Aug 032018
 
Scheduled nebulization with acetylcysteine didn't help ventilated patients

by Salynn Boyles, Contributing Writer, MedPage Today Regular nebulization proved to be no more effective than nebulization on demand in a randomized trial involving critically ill patients receiving invasive ventilation, researchers reported. Among ICU patients expected to need invasive ventilation for at least 24 hours, scheduled nebulization four times a day involving acetylcysteine with salbutamol did not [… read more]

Jul 252018
 
FDA approves new hyperkalemia drug Lokelma

The FDA approved oral sodium zirconium cyclosilicate (ZS-9), to be marketed as Lokelma, for the treatment of hyperkalemia. The drug seems to work better than sodium polystyrene sulfonate (Kayexalate), reducing serum potassium levels within an hour and restoring normal levels after about 2 hours in most patients. The drug was tested against placebo (not Kayexalate) [… read more]

Jul 232018
 
Sodium Bicarbonate Administration in Severe Metabolic Acidemia: the BICAR-ICU Trial

Jon-Emile S. Kenny MD [@heart_lung] “What is REAL?” -Velveteen Rabbit A 42 year old woman with poorly-controlled type II diabetes is admitted with a severe soft tissue infection of her left lower extremity.  She is hypotensive with altered sensorium and she is noted to have a rapidly progressing border of deep, crimson erythema and edema [… read more]

Jul 202018
 
Prophylactic Precedex prevented delirium in ICU patients

Quick Take: This small (n=100), two-center, industry-funded (Hospira) study showed a remarkable 80% prevention rate of ICU delirium (compared to 20% with placebo) with patients given dexmedetomidine prophylactically during their ICU stay. Although associated with poor outcomes in critically ill patients, delirium is not known to be an independent predictor of those outcomes. This small [… read more]

Jul 202018
 
Pulmonary Embolism Causes <1% of Syncope in ER, Study Argues

by Nicole Lou, Contributing Writer, MedPage Today Researchers concluded from a large retrospective study that pulmonary embolism is unlikely to cause syncope that results in a trip to the emergency room. Fewer than 1% of nearly 1.7 million patients treated at emergency departments for syncope had pulmonary embolism, according to databases from Canada, Denmark, Italy, and the [… read more]