Feb 212019
 
Theophylline as add-on therapy was no use in preventing COPD exacerbations

Theophylline is derived from methylxanthine, naturally present in tea and cocoa beans. Initially used medically in 1895 as a diuretic, theophylline was one of the first drugs for asthma and COPD/emphysema (beginning in 1922), after its bronchodilation effects were discovered. Theophylline also has cardiac and central nervous system stimulant side effects and can produce tachyarrhythmias [… read more]

Feb 172019
 
Echocardiography Does Not Correlate with Volume Status says CoDE-MiN Study

Jon-Emile S. Kenny MD [@heart_lung] “Nolite te bastardes carborundorum” -Margaret Atwood Case An 86 year old woman presents with two days of decreased intake by mouth and 3 days of melena and vomiting.  She is followed closely by her internist and cardiologist for hypertension, severe mitral regurgitation, pulmonary venous hypertension and right ventricular dysfunction with co-morbid [… read more]

Feb 172019
 
FDA approves new anti-influenza drug Xofluza; worked better than oseltamivir

The U.S. Food and Drug Administration (FDA) approved baloxavir marboxil, an oral tablet to be marketed as Xofluza, for treatment of early acute uncomplicated influenza in adolescents and adults. FDA Commissioner Scott Gottlieb said in a news release, This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA [… read more]

Feb 172019
 
FDA warns of aortic dissection with fluoroquinolones

After a review of reported adverse events, the U.S. FDA is warning physicians that fluoroquinolone antibiotics may increase the occurrence of aortic dissections, resulting in aortic rupture and death. FDA used unusually direct language in advising, “Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.” Patients [… read more]

Feb 172019
 
Cricoid pressure no help during endotracheal intubation in large trial

Pressing fingers against the cricoid cartilage (the Sellick maneuver) during rapid sequence intubation compresses the esophagus beneath the firmer trachea. It has long been espoused that this prevents aspiration (emesis or reflux of gastric contents into the supraglottic space and airway, obscuring the operator’s view and harming the patient). The Sellick maneuver is believed to [… read more]

Feb 082019
 
Former Vanderbilt nurse arrested, charged with homicide for medication error

Tennessee law enforcement agents announced they had arrested and charged a nurse with reckless homicide and patient abuse for a fatal medication error she allegedly committed while working at Vanderbilt University Medical Center in December 2017. The charges allege that the nurse intended to provide an ordered dose of midazolam (Versed) to an anxious patient [… read more]

Feb 082019
 
Decontaminating patients did not reduce bloodstream infections

A large proportion of patients who remain in ICUs for more than a few days develop hospital-acquired infections, including bloodstream infections. Indwelling urinary or venous catheters, gut translocation, aspiration and impaired host defenses can all be causative. Bloodstream infection incidence has been reduced over time, but remains persistently ineradicable. One enticing method of prevention has been [… read more]

Feb 082019
 
Primatene Mist for asthma goes back on the market

by John Gever, Managing Editor, MedPage Today WASHINGTON — Primatene Mist, the over-the-counter epinephrine inhaler for quick asthma relief, can go back on the market in a reformulated version, the FDA said. Now using a hydrofluoroalkane (HFA) propellant in place of the banned chlorofluorocarbon (CFC) used in the original Primatene product (and most other asthma inhalers), the new [… read more]

Feb 032019
 
ICU Physiology in 1000 Words: Blood Pressure

Jon-Emile S. Kenny MD [@heart_lung] Why is blood pressure measured by units of length [i.e. millimeters of mercury – mmHg]?  What decides systolic and diastolic pressure?  What are the determinants of tissue perfusion and what are the clinical implications of this physiology?  Can we deceive ourselves into thinking a particular mean arterial pressure [MAP] is [… read more]

Feb 022019
 
FDA approves revefenacin (Yupelri) for COPD

The U.S. Food and Drug Administration (FDA) approved revefenacin inhalation solution to be marketed as Yupelri for ongoing treatment of patients with chronic obstructive pulmonary disease (COPD). Yupelri will be marketed by Theravance Biopharma. Revefenacin is the first once-daily nebulized bronchodilator approved for COPD in the U.S., according to its manufacturer. Revefenacin is a long-acting muscarinic antagonist. In randomized trials, 3 [… read more]

Jan 242019
 
For most critically ill patients, a 'starvation diet' seems just fine (TARGET trial)

Very little evidence guides nutrition in critical illness. Because of critically ill patients’ catabolic state, and probably influenced by the normalization fallacy, nutrition practices often include efforts to provide daily calories in the 1,800 – 2,000 range. However, anorexia may be adaptive during illness (since it is common to multiple disease states); greater enterally infused [… read more]

Jan 232019
 
Is Critical Care Medicine becoming a Cargo Cult of Vitamin C?

By Nicholas Mark, MD During the 1940s, many Melanesian cultures were profoundly altered as the Second World War was waged in the Pacific around them. Western soldiers constructed airstrips out of the jungles and the natives witnessed vast wealth in the form of manufactured goods literally rain down from the skies on parachutes or carried [… read more]

Jan 162019
 
Atrial Fibrillation for the Intensivist – part 2

Jon-Emile S. Kenny MD [@heart_lung] “I’m burnin’ through the sky, yeah Two hundred degrees, That’s why they call me Mister Fahrenheit” -Freddie Mercury Part 1 gave a brief overview of the mechanisms of atrial fibrillation [AF] as well as pertinent features of rate controlling agents and anticoagulation.  In this brief second part, nuanced features of ventricular [… read more]

Jan 152019
 
Atrial Fibrillation for the Intensivist – part 1

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “The habit of writing for my eye is good practice. It loosens the ligaments.” ― Virginia Woolf Case A 28 year old woman with known severe mitral stenosis from rheumatic heart disease presents with acute onset shortness of breath.  Her acute dyspnea began while [… read more]

Jan 132019
 
Vitamin D supplementation reduced COPD exacerbations in deficient patients: meta-analysis

by Salynn Boyles, Contributing Writer, MedPage Today Vitamin D supplements reduced moderate to severe COPD exacerbations in patients with low circulating levels of its 25-hydroxyvitamin D (25-OH-D) metabolite at baseline, a meta-analysis indicated. But no such effect was seen for patients with at least normal 25-OH-D levels (at least 25 nmol/L) prior to supplementation, according to Adrian [… read more]

Jan 092019
 
Hospitals should not implement one-hour sepsis bundles, say SCCM and ACEP

In an unusual turn, the Society for Critical Care Medicine (SCCM) is advising against implementation of the one-hour sepsis bundle originally advocated in Spring 2018 by committee members of its Surviving Sepsis Campaign. SCCM and American College of Emergency Physicians (ACEP) issued a joint statement in which they acknowledged “concerns expressed about the recently released Surviving [… read more]

Jan 062019
 
Keep O2 saturations at 96% or below for hospitalized patients: expert panel

For acutely ill patients, oxygen saturation should not exceed 96%, an international panel recommended. A multidisciplinary team of clinicians was brought together by The BMJ as part of the Rapid Recommendation initiative to focus on the most effective approach to oxygen therapy for patients with acute medical illness. The team used findings from an April 2018 systematic [… read more]

Jan 012019
 
Best of 2018 on PulmCCM

Best of 2018:       Prone positioning for severe ARDS advised by major societies    2018 Update to Surviving Sepsis Guidelines: Cue Backlash   Management of Ground Glass and Subsolid Pulmonary Nodules: Review   Vasopressors and Inotropes for Shock Syndromes: Review     Prophylactic Precedex prevented delirium in ICU patients   Corticosteroids do help [… read more]

Dec 312018
 
ICU Physiology in 1000 Words: Systolic Time Intervals

Jon-Emile S. Kenny MD [@heart_lung] Remarkably, non-invasive cardiology did not begin with ultrasound but rather as investigations into systolic time [1].  Indeed, studies on the duration of systole began in 1875 with Garrod who showed that the left ventricular ejection time [LVET] – the time that the aortic valve is open and ejecting blood – varies [… read more]

Dec 162018
 
Dupilumab as add-on biologic improved allergic asthma outcomes

by Salynn Boyles, Contributing Writer, MedPage Today  SEATTLE — Add-on treatment with the biologic therapy dupilumab (Dupixent) was associated with reduced severe exacerbations and improved lung function in patients with allergic asthma in a post-hoc analysis of phase III data from the Liberty Asthma Quest study reported here. The analysis compared outcomes in patients with allergic disease versus those [… read more]