Medicare announced it will now pay for a new molecular tissue test for idiopathic pulmonary fibrosis, called the Envisia Genomic Classifier (Veracyte). The availability of the new assay reshuffles the algorithm for the diagnosis of IPF, forcing consideration of transbronchial biopsy in some patients. However, professional societies do not yet endorse its general use. The [… read more]
Electromagnetic navigation bronchoscopy (ENB) can allow biopsy of peripheral pulmonary nodules that are usually not accessible with conventional bronchoscopy. Navigational bronchoscopy requires specialized training and equipment costing hundreds of thousands of dollars, and is not widely available outside urban centers. Multiple studies have reported varying yields and complication rates with ENB, but most have been [… read more]
Undergraduate biomedical engineering students have developed the first prototype of a laryngoscope blade whose future iterations could allow novices or robots to intubate patients as well as expert humans. The new laryngoscope blade has embedded force sensors that calculate its location in the airway. The sensors were trained using machine learning, with tactile patterns generated [… read more]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
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]
“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]
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]
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]
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]
Get PulmCCM’s Weekly Email Update
Stay up-to-date in pulmonary and critical care. No spam.