Tracheostomy in COVID-19: Many opportunities, limited evidence By Andrew DeMaio, M.D. and David Feller-Kopman, M.D. Let’s start with a case – one that unfortunately we have seen way too frequently over the past few months. A 61-year-old man with ESRD on hemodialysis and prior pulmonary embolism was admitted to the ICU for ARDS due to [… read more]
A new randomized trial showed no benefit from intravenous vitamin C in patients with sepsis, but delays in treatment baked into the trial design will keep hope alive for true believers in the novel therapy. Vitamin C, hydrocortisone, and thiamine have been promoted as a lifesaving adjunctive therapy for septic shock, based on anecdotal data [… read more]
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Vitamin D supplementation brought no measurable benefits to vitamin D-deficient critically ill patients, in a large randomized trial published in the New England Journal of Medicine. Vitamin D supplementation has long been hoped for as a potential lifesaving therapy in critical illness. Many critically ill patients are vitamin D deficient, and deficiency increases the risk [… read more]
Best of 2019 on PulmCCM: Keep O2 saturations at 96% or below for hospitalized patients, says expert panel Major asthma guideline update: ICS-LABA as-needed replaces albuterol 2019 IDSA Guidelines for Community Acquired Pneumonia Prolonged hypothermia improved neurologic outcomes after non-shockable cardiac arrests Hospitals should not implement one-hour sepsis bundles, say SCCM and ACEP Vitamin C [… read more]
New Guideline Emphasizes Treatment of Drug-Resistant Tuberculosis with All-Oral Regimens for MDR-TB Patients The American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society and the Infectious Diseases Society of America have published an official clinical guideline on the treatment of drug-resistant tuberculosis (DR-TB) in the Nov. 15 American Journal of Respiratory and [… read more]
by Zeena Nackerdien PhD, CME Writer, MedPage Today Recent estimates point to a rise in NTM lung disease in the U.S., particularly among those older than 50 or those with chronic underlying lung diseases, such as non-cystic fibrosis bronchiectasis, cystic fibrosis, and emphysema. According to a 1997-2007 estimate of the Medicare population (≥65 years old), NTM lung [… read more]
By Salynn Boyles, Contributing Writer, MedPage Today Tweaking a widely accepted strategy for assessing pulmonary embolism risk ruled out thrombosis and reduced chest imaging by a third among low-risk patients enrolled in a prospective study. Assessment of clinical pretest probability (C-PTP, calculated by the Wells score) and blood D-dimer level are used to assess pulmonary embolism [… read more]
More than 32 million people in the U.S. have reported penicillin allergies — about 10% of the population. But almost 95% of them are not penicillin-allergic, and are removing themselves from eligibility for ideal antibiotic treatments, according to a review in JAMA. “More than 1 in 10 people who seek medical care self-report a history [… read more]
Inhaled corticosteroids have been the mainstay of treatment for persistent asthma for decades. A new trial suggests that for the ~50% of asthma patients with low sputum eosinophils, inhaled steroids are no better than placebo, and neither was tiotropium. Treatment with the inhaled glucocorticoid mometasone or the long-acting muscarinic antagonist tiotropium resulted in similar outcomes [… read more]
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]
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