As a few of you found out with some frustration, the password reset function (to get access to the PulmCCM quizzes) has been glitchy. Occasionally the password reset emails were not delivered, even to your spam folder. Sorry about that. This should be fixed now. Click the link below to get a new password. This [… read more]
Delirium occurs in a large proportion of critically ill patients, and ICU patients who get delirious tend to have longer hospital stays and higher mortality. However, it has never been shown that delirium independently increases the risk for poor outcomes, or is a fellow traveler, a marker of more severe disease and vulnerability. Critical care [… read more]
The new generation of oral anticoagulants have revolutionized management of venous thromboembolism and atrial fibrillation. The changes in clinical practice have also created new questions and confusion around management of bleeding associated with these newer anticoagulants. The American College of Cardiology issued an expert consensus document in December 2017 to help guide physicians on the [… read more]
Observational studies of patients in sepsis strongly suggest that outcomes are improved by giving antibiotics as soon as possible after recognition of sepsis. The Surviving Sepsis Campaign recently decided everyone with suspected sepsis should receive antibiotics within one hour of emergency department arrival. So why not give antibiotics before the patient even arrives to the [… read more]
The FDA approved a new indication for the antibiotic combination ceftazidime and avibactam (marketed as Avycaz), for treatment of hospital-acquired pneumonia and ventilator-associated pneumonia in adults. The drug was approved originally in 2015 for complicated intra-abdominal infections (in combination with metronidazole) and got another indication in 2017 for complicated urinary tract infections and pyelonephritis. The [… read more]
Intensivists may get all the credit, but over 37,000 hospitalists provide much of the care for ICU patients in the U.S. According to a recent survey, they often do it without the presence or availability of intensivists for consultation or support, especially outside urban centers. The internists aren’t happy about it, feeling uncomfortable, unsupported and [… read more]
Most patients with cancer-associated deep venous thrombosis (DVT) or pulmonary embolism (PE) in the U.S. are treated indefinitely with subcutaneous injections of low-molecular weight heparin (LMWH), like enoxaparin. LMWH has been shown to be better than warfarin at preventing DVT/PE in cancer patients, with similar rates of bleeding. A new generation of oral anticoagulants have [… read more]
The U.S. Food and Drug Administration (FDA) warned health care teams about the risk of pneumothorax caused by certain enteral feeding tubes that use technology to guide their insertion, also called enteral access systems (EAS). It issued a safety communication stating, Most reports indicate these pulmonary events required urgent intervention, including needle decompression or chest [… read more]
Since Marik et al announced exceptional survival rates among patients with septic shock given a cocktail of vitamin C, thiamine, and hydrocortisone, physicians taking care of septic patients have expressed both enthusiasm and skepticism about the cocktail’s reported lifesaving effects. Soon, more rigorous testing from randomized, double-blind placebo-controlled trials should provide harder data about the [… read more]
Bougies are long, stiff plastic wands inserted into the trachea through the glottis during direct laryngoscopy (DL), providing a “guidewire” over which an endotracheal (ET) tube can then be more easily advanced into the trachea. Bougies have traditionally been used after one or more failed intubation attempts with direct laryngoscopy, at which point the airway [… read more]
Infusing antipseudomonal beta-lactam antibiotics over longer periods could save lives in sepsis over intermittent bolus dosing, according to a systematic review and meta-analysis of randomized trials. Vardakas et al aggregated data from studies of patients with sepsis receiving infusions of carbapenems, cephalosporins, and penicillins with antipseudomonal activity. Studies included compared prolonged infusion (over at least three [… read more]
by Salynn Boyles, Contributing Writer, MedPage Today Cardiovascular event risk may increase in smokers who start using the cessation-assist drug varenicline (Chantix), according to findings from an observational study. The retrospective analysis of medical records for close to 57,000 new users of varenicline living in Ontario, Canada, showed a statistically significant 34% increased risk for [… read more]
Another study shows that indwelling pleural catheters and talc pleurodesis appear equivalent in efficacy, each with its own pros and cons in hospital length of stay and adverse event risk. Malignant pleural effusions tend to recur increasingly frequently, such that repeated thoracentesis becomes an inviable option. For these patients, talc pleurodesis or placement of an [… read more]
In February 2017, the FDA approved Immunexpress’s SeptiCyte, a molecular test with an indication for diagnosing sepsis on the first day of ICU treatment. The test isn’t widely available, but that may change soon: the manufacturer announced a partnership with Biocartis, whose rapid-PCR testing platform could bring SeptiCyte into use in ICUs throughout the developed [… read more]
The Pittsburgh International Lung Conference is an educational conference held every other year to increase awareness of the medical and scientific advances being made in treating lung disease. The 2018 Pittsburgh International Lung conference will be hosted by the Division of Pulmonary and Critical Care Medicine at the University of Pittsburgh, a leader in Pulmonary Medicine, [… read more]
Introduction Respiratory failure is a commonly encountered disease process in both the emergency department (ED) and intensive care (ICU) setting. Respiratory failure most frequently results from exacerbations of congestive heart failure (CHF) or chronic obstructive pulmonary disease (COPD), respiratory infections, encephalopathy, or a combination of these etiologies. Obesity, with or without obesity hypoventilation syndrome, reduces [… read more]
In their 2018 update, the Surviving Sepsis Campaign’s guidelines attempt to accelerate care delivery for sepsis, advising that within one hour, physicians and health care teams should collect blood cultures and lactate, begin 30 ml/kg fluid resuscitation for hypotension or lactatemia, and start vasopressors for selected patients. Previously, these interventions were advised within three- and [… read more]
by Crystal Phend, Senior Associate Editor, MedPage Today Thrombolytics delivered to acute proximal deep-vein thrombus (DVT) with clot removal did not reduce the risk of post-thrombotic syndrome but did raise major bleeding risk over anticoagulant treatment alone in the Acute Venous Thrombosis: Thrombus Removal with Adjunctive Catheter-Directed Thrombolysis (ATTRACT) clinical trial. The proportion of patients with post-thrombotic [… read more]
Procalcitonin (PCT) levels can be useful (although limited) in deciding whether and when to start, de-escalate, and stop antibiotic therapy in patients with suspected infection. Physicians’ use of procalcitonin in antibiotic decisions has exploded since the FDA approval of a PCT assay whose manufacturer provides specific (albeit oversimplified) cut-off values at which to consider infection [… read more]
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