PulmCCM

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

Feb 162018
 
Ruling Out PE in the ED: Critical Analysis of the PROPER Trial

By Scott Aberegg, M.D., M.P.H. This post is going to be an in-depth “journal club” style analysis of the PROPER trial. In this week’s JAMA, Freund et al report the results of the PROPER randomized controlled trial of the PERC (pulmonary embolism rule -out criteria) rule for safely excluding pulmonary embolism (PE) in the emergency department (ED) [… read more]

Feb 152018
 
PERC Can Safely Rule Out Pulmonary Embolism in ED Setting

By Salynn Boyles, Contributing Writer, MedPage Today A clinical assessment protocol proved to be as effective as blood testing and CT imaging in the emergency department setting for ruling out pulmonary embolism in very low-risk patients in a newly reported French clinical trial. The crossover cluster-randomized PROPER study was conducted at 14 emergency departments (EDs) in France [… read more]

Feb 142018
 
FDA Approves New Cystic Fibrosis Drug Combo

Vertex Pharmaceuticals won FDA approval for its third drug to treat cystic fibrosis, the company announced. Ivacaftor (Kalydeco) combined with tezacaftor, a new agent, will be sold as Symdeko. Symdeko was approved for patients age 12 or older who are homozygous for the F508 deletion of the CFTR gene, or who have another mutation that [… read more]

Feb 112018
 
Vasopressors and Inotropes for Shock Syndromes: Review

Overview Vasopressors and inotropes are cornerstones in the management of shock syndromes. Understanding vasopressors’ receptor activity and resultant pharmacological response enables clinicians to select the ideal vasopressor(s) for a patient suffering from shock. The following table outlines common vasopressors/inotropes and their general receptor activity profiles.1,2 Drug Dose α1 ß1 ß2 DA V1 V2 cAMP Norepinephrine [… read more]

Feb 062018
 
Meta-analysis: statins for COPD associated with better walk distance and quality of life

By Salynn Boyles, Contributing Writer, MedPage Today Treatment with statins may be beneficial in terms of improving exercise tolerance, pulmonary function and quality-of-life among chronic obstructive pulmonary disease (COPD) patients with co-existing cardiovascular disease, increased systemic inflammation or hyperlipidemia. That is the finding from meta-analysis of 10 randomized, controlled trials involving close to 1,500 patients, [… read more]

Jan 302018
 
Lung cancer screening with CT: Does it work in the real world?

The first real-world results from a population-based deployment of lung cancer screening are in, from a demonstration project at Veterans Affairs (VA) hospitals. Screening was generally effective at identifying early-stage lung cancer, but with far more effort per cancer detected than in the seminal National Lung Screening Trial. High false positive rates led to a [… read more]

Jan 262018
 
FDA Approves First Nebulized LAMA for COPD

by Salynn Boyles, MedPage Today The FDA approved a nebulized formulation of glycopyrrolate (Lonhala Magnair) for long-term maintenance treatment of patients with moderate-to-severe COPD, said manufacturer Sunovion Pharmaceuticals. It’s the first long-acting muscarinic antagonist (LAMA) to be sold in this form. Recommended dosing is 25 mcg twice daily. The approval was made on the strength of data [… read more]

Jan 202018
 
Prone positioning for severe ARDS advised by major societies

In case you missed it, major professional societies in critical care now strongly recommend prone positioning for patients with severe acute respiratory distress syndrome (ARDS), with a PaO2-to-FiO2 (P/F) ratio of ≤ 100. The recommendation marks a major shift in advised care for ARDS. Prone positioning improves ventilation-perfusion matching (transferring delivered oxygen into the bloodstream more [… read more]

Jan 182018
 
FDA Approves Benralizumab for Severe Asthma

by Salynn Boyles Contributing Writer, MedPage Today The FDA has approved AstraZeneca’s biologic drug benralizumab (Fasenra) for the add-on maintenance treatment of patients age 12 years and over with severe asthma with an eosinophilic phenotype, the drugmaker announced. Approval was based on pivotal trials showing up to a 51% reduction in the annual asthma exacerbation [… read more]

Jan 172018
 
Vitamin D improved asthma symptoms and reduced exacerbations

Multiple randomized trials have suggested that vitamin D supplementation might improve asthma control and reduce severity of asthma attacks. A new meta-analysis bolsters that hypothesis, and may encourage more physicians and people with asthma to consider vitamin D supplements for low vitamin D levels. In a study in Lancet Respiratory Medicine, authors analyzed the experience [… read more]

Jan 152018
 
Weekend hospital admissions associated with increased risk of death

“Don’t get admitted to the hospital on a weekend.” Listen, and you might hear that rueful advice muttered under the breath of a frustrated physician unable to get a prompt Saturday consultation or procedure, the requested specialist being at another hospital, or maybe her son’s soccer game. The weekend effect — patients admitted on a [… read more]

Jan 152018
 
N-acetylcysteine (NAC), sodium bicarbonate no help in preventing contrast nephropathy

N-acetylcysteine (NAC) and sodium bicarbonate are commonly provided to patients undergoing angiographic procedures with intravenous contrast. Small randomized trials had suggested NAC or bicarbonate or both could prevent kidney injury from so-called contrast nephropathy. That practice has no benefit, based on results of a large randomized trial showing neither NAC nor bicarb improved outcomes after [… read more]

Jan 152018
 
Annual Asthma-Related Expenditures in U.S. Exceed $80 Billion

by Salynn Boyles, Contributing Writer, MedPage Today  Asthma costs the U.S. economy more than $80 billion a year in medical expenditures, missed school and work days, and deaths, according to CDC researchers. The condition is responsible for 8.7 million lost workdays and 5.2 million lost school-days annually, at an estimated cost of around $3 billion, reported Tursynbek [… read more]

Jan 072018
 
Management of Ground Glass and Subsolid Pulmonary Nodules: Review

Authors: Samuel Copeland, MD; Ebtesam Islam, MD, PhD Pulmonary nodules are small, generally spherical abnormalities, commonly noted incidentally on chest radiography or computed tomography1. Ground glass opacifications (GGO) are a subset of pulmonary nodules or masses with non-uniformity and less density than solid nodules. GGO are usually described as either pure ground glass or part solid [… read more]

Jan 042018
 
Apply for the ALiEM Faculty Incubator Before Feb 3!

Junior faculty members: Looking for a way to bolster your academic credentials and engage/network with an established community of medical educators? The ALiEM (Academic Life in Emergency Medicine) Faculty Incubator is a yearlong online faculty development program (limited to 30 participants yearly), nearly exclusively done with online asynchronous interactions through the Slack platform. The incubator [… read more]

Jan 012018
 
Best of 2017 on PulmCCM

Here are the top articles from 2017 on PulmCCM: Meta-analysis confirms EGDT for sepsis is unhelpful and wasteful (PRISM) Could vitamin C save lives in sepsis? These hospitals aren’t waiting for proof. Surviving Sepsis Guidelines: A Review and Analysis Intubation during CPR was associated with worse survival and brain health FDA Approves Angiotensin-II for Septic [… read more]

Dec 222017
 
FDA Approves Angiotensin-II for Septic Shock

The FDA approved angiotensin-II (Giapreza) as a new intravenous vasopressor for septic shock and other forms of distributive shock. The first new FDA-approved vasopressor in decades, angiotensin-II could significantly change the management of severe septic shock. FDA based its expedited approval (under priority review) on the ATHOS-3 trial enrolling 321 patients with shock refractory to [… read more]

Dec 222017
 
FDA approves low-dose rivaroxaban for long-term PE/DVT prevention

The long-term management of recurrent venous thromboembolism continues to evolve with the FDA’s approval of once-daily low-dose rivaroxaban, now indicated for patients with recurrent deep venous thrombosis or pulmonary embolism who have completed at least six months of anticoagulation. FDA approved low-dose rivaroxaban based on data from 3,395 patients in the EINSTEIN-CHOICE study. Both 20 [… read more]

Dec 212017
 
FDA: No excess risk of asthma death from LABA/ICS inhalers; warnings removed

Combination inhalers for asthma and COPD containing long-acting beta agonists (LABA) drugs along with inhaled corticosteroids can lose their black-box warnings about their previously-theorized risk of asthma-related death, the FDA announced. The original boxed warning came in 2011 in the wake of a small number of asthma-related deaths among patients taking LABA monotherapy (without inhaled [… read more]