PulmCCM

The PulmCCM team writes the posts under this moniker. Read the About page for more of the PulmCCM story.

Nov 172019
 
Vitamin E acetate in THC liquid is major cause of vaping lung injury, says CDC

The CDC has concluded that vitamin E acetate in vaping oils containing THC (tetrahydrocannabinol) is responsible for many cases of vaping-related lung injury. There have been over 2,051 confirmed and probable cases of e-cigarette or vaping-associated lung injury (EVALI), with 39 deaths. CDC made its advisement based on the consistent presence of vitamin E acetate [… read more]

Nov 172019
 
Beta-blockers doubled risk of hospitalization from COPD exacerbations (BLOCK-COPD)

Beta-blockers have generally been considered safe and beneficial for patients with COPD, but a new randomized trial calls that assumption into doubt. The use of oral beta blockers without a cardiac indication appeared to double the risk of hospitalization for people experiencing a COPD exacerbation. Authors randomized 532 patients with moderate or severe COPD with [… read more]

Nov 082019
 
New guidelines on obesity hypoventilation syndrome released

Tens of millions of adults in the U.S. have obstructive sleep apnea (OSA), but most are mild cases that pose low health risks. A greater danger is faced by the smaller number of people with sleep apnea that progresses to obesity hypoventilation syndrome (OHS), a life-threatening condition. Obesity hypoventilation syndrome — an impairment in resting [… read more]

Nov 082019
 
Can C-reactive protein improve treatment for COPD exacerbations?

Use of C-reactive protein (CRP) in decision-making may reduce antibiotic use in COPD exacerbations, but not as a replacement for clinical judgment, a study suggested. Chronic obstructive pulmonary disease (COPD) exacerbations are characterized by increased inflammation in the airways and the body generally. C-reactive protein (CRP) is a serum test for inflammation, and has been [… read more]

Nov 072019
 
In sepsis, antibiotics reduced yield of blood cultures by almost 40%

by Molly Walker, Associate Editor, MedPage Today If you want an accurate reading from sepsis patients’ blood cultures, don’t start antibiotics until you’ve drawn the blood samples, a new study suggested. Among patients with severe sepsis, blood cultures taken prior to antibiotic therapy were positive for one or more microbial pathogens in 31.4% of patients [… read more]

Oct 312019
 
Vitamin C reduces mortality from sepsis with ARDS in CITRIS-ALI randomized trial ... ?

Vitamin C infusion has generated tremendous interest as an adjunctive treatment for patients with sepsis, since a widely publicized cohort study claimed vitamin C dramatically reduced sepsis-related mortality at a single institution. The publicity, the plausible pathophysiologic mechanism, and the lack of any therapy for sepsis have led many intensivists to prescribe the so-called Marik [… read more]

Oct 182019
 
Prolonged hypothermia improved neurologic outcomes after non-shockable cardiac arrests (HYPERION, CRICS-TRIGGERSEP)

Targeted temperature management (TTM, or therapeutic hypothermia) has become standard therapy after cardiac arrest, especially for ventricular tachycardia and fibrillation–so called shockable rhythms. A new randomized trial has shown that deep, prolonged cooling after cardiac arrest from non-shockable rhythms (PEA and asystole) improved neurologic outcomes. But how robust were the results, and should they change [… read more]

Oct 112019
 
Major asthma guideline update: ICS-LABA as-needed replaces albuterol

In their first major update in 30 years, newly published asthma guidelines recommend significant changes to the way physicians treat millions of patients diagnosed with asthma. The Global Initiative for Asthma (GINA) now advises that, in general: Most people with asthma can now be prescribed just one inhaler: an inhaled corticosteroid-and-long-acting beta agonist (ICS-LABA) combination [… read more]

Sep 062019
 
Prophylactic IVC filters prevent PE in high-risk trauma patients, but were often unnecessary

Inferior vena cava filters placed prophylactically in patients hospitalized for trauma prevented symptomatic pulmonary embolism in those patients with persistent contraindications to anticoagulation, in a significant randomized trial. However, prophylactic IVC filter placement for all post-trauma patients did not improve outcomes generally. Trauma teams have always faced a difficult dilemma in the prevention and treatment [… read more]

Sep 032019
 
Advisory from CDC re: Severe Pulmonary Disease Associated with Using E-Cigarette Products

From the Centers for Disease Control and Prevention (CDC) and distributed here in the interest of the public health. PulmCCM is not affiliated with the CDC. Distributed via the CDC Health Alert Network August 30, 2019, 0935 AM ET (9:35 AM ET) CDCHAN-00421 The Centers for Disease Control and Prevention (CDC) is providing: 1) background [… read more]

Sep 022019
 

Update 9/6/19: we removed the video at Jon’s request.  Frequent PulmCCM contributor Jon-Emile Kenny is also a co-founder of the medical device start-up Flosonics Medical who (as I understand it) are working to develop and market a wearable ultrasound patch that would help direct fluid resuscitation and vasopressor use in patients in shock. PulmCCM has [… read more]

Jun 092019
 
Dexmedetomidine helpful but inadequate alone for sedation (SPICE III)

In a new randomized trial, use of dexmedetomidine (Precedex) as the primary sedative in mechanically ventilated patients in the ICU resulted in no reduction in 90 day mortality. Dexmedetomidine resulted in a small improvement in delirium and ventilator days, but was almost never adequate to sedate patients on its own, and brought a small increase [… read more]

May 302019
 
Neuromuscular blockade for ARDS was no help, in supine patients

Continuous neuromuscular blockade for severe ARDS became common practice after the ACURASYS trial (2010) showed it reduced mortality by an absolute 9%. A larger trial, ROSE, now finds no benefit of the therapy over usual care — but leaves lingering questions due to major design differences. The ROSE trial was a multicenter randomized trial in [… read more]

Apr 162019
 
More than 90% of sepsis deaths are unpreventable, study concludes

“Nihilist” is one of the harshest insults that can be lobbed at a physician. Even while one knows intellectually that every patient can’t be saved, it’s considered odious to openly acknowledge that actuarial reality. Accepting the truth that some patients will inevitably die despite our best efforts is seen by some as the threshold of [… read more]

Apr 142019
 
Titrating PEEP using esophageal pressures did not improve ARDS outcomes (EPVent-2)

In acute respiratory distress syndrome (ARDS), using pleural pressure to adjust positive end-expiratory pressure (PEEP) has long been considered a cumbersome but theoretically ideal technique to optimize ventilator management. Using esophageal pressure as a surrogate for pleural pressure can allow one to calculate and minimize the transpulmonary pressure gradient, elevations in which are the putative [… read more]

Apr 142019
 
Overnight in-house intensivists don't clearly improve care: Review

A review of studies comparing 24/7 in-house intensivist physician coverage with less-intensive models (with no intensivist in the ICU overnight) found no clear or consistent benefits associated with in-house intensivist coverage. Authors informally reviewed about 50 previous studies and meta-analyses. They concluded that in-house intensivists overnight might reduce ICU length of stay by a few [… read more]

Apr 072019
 
Bag-mask ventilation during intubation in ICU prevents severe hypoxemia

A randomized trial confirmed what most intensivists have long believed and practiced: in the moments before endotracheal intubation, we should help patients achieve the highest arterial oxygen saturation possible, using bag-mask ventilation (BMV). This seems self evident — why wouldn’t we? Bag-mask ventilation can distend the stomach with air, potentially increasing the risk for vomiting [… read more]

Apr 072019
 
Early norepinephrine improved septic shock, prevented pulmonary edema

Guidelines advise physicians give large boluses of intravenous crystalloid infusions (two to three liters, generally) to patients with septic shock. Vasopressors are typically begun only if patients’ blood pressure remains low after fluid administration. A vocal minority of researchers have advised against delaying vasopressors in septic shock, arguing that norepinephrine, not intravenous fluid, is the [… read more]

Apr 072019
 
Andexanet works as antidote to apixaban, rivaroxaban, data show

by Nicole Lou, Contributing Writer, MedPage Today HONOLULU — Andexanet alfa (Andexxa), the reversal agent for anticoagulants in the factor Xa inhibitor class, worked for patients who developed acute major bleeding while on one of these agents, the full report of the ANNEXA-4 study confirmed. A bolus of the antidote saw median anti-factor Xa activity drop more [… read more]

Mar 312019
 
Intensive glucose management again fails to help -- this time, in stroke

Intensive insulin therapy to maintain blood glucose in the normal range has  immense intuitive appeal. Hyperglycemia is associated with bad outcomes in numerous conditions, and we have the tools at hand to rigorously control it. How could that not help people? Unfortunately, intensive insulin therapy doesn’t seem to help at all, and may harm patients. [… read more]