PulmCCM

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

Nov 252016
 
Life-sucking power of electronic health records measured, reported, lamented

Feel like you spend twice as much time on your electronic health record as you do with patients? You may be doing better than half of your colleagues. In a new work study funded by the American Medical Association, researchers observed 57 physicians in internal medicine, family medicine, cardiology, and orthopedics over hundreds of hours. They discovered [… read more]

Nov 232016
 
Breo Ellipta beat usual care for COPD in real-world study

GlaxoSmithKline recently got a boost for fluticasone-furoate + vilanterol (Breo Ellipta), its new once-daily COPD maintenance inhaler. Patients with COPD randomized to Breo Ellipta (called Relvar Ellipta in Europe), instead of usual care, had 8% fewer exacerbations and no increased risk for serious adverse events over one year. GSK presented the data at the ERS [… read more]

Nov 182016
 
Does intensive rehab and physical therapy in the ICU really help?

Every year, over a million people in the U.S. suffer respiratory failure requiring mechanical ventilation. They experience enormous catabolic stress, extended periods of inactivity, and usually go without their usual caloric intake. It’s no surprise that many are rendered profoundly debilitated by the experience. For many, this weakness and loss of muscle mass represents a second [… read more]

Nov 172016
 
Older transfused blood as good as fresh (INFORM)

What’s the shelf life of human blood? Like the milk in your fridge, stored donated human blood has an expiration date: currently it’s 42 days, set by the FDA. But is fresher blood actually better? As with ordering wine by the glass, should patients about to be transfused blood ask for “whatever was opened most recently”? There’s [… read more]

Nov 092016
 
Almost half of intensivists feel severe burnout, report says

Almost half of critical care physicians report symptoms of severe burnout associated with their ICU work, according to a report and “call to action” from the Critical Care Societies Collaborative (CCSC). Symptoms of severe burnout were highest among pediatric critical care specialists, while 45% of intensivists caring for adults acknowledged severe burnout. Burnout symptoms include [… read more]

Nov 082016
 
CPAP did not reduce cardiovascular risk, especially when not worn

Nightly use of continuous positive airway pressure (CPAP) did not prevent cardiovascular events in high risk patients with obstructive sleep apnea, according to a large randomized trial. The SAVE study suggests that CPAP has no cardiovascular benefits for the millions of people using it less than 4 hours a night. However, those using CPAP for more [… read more]

Nov 022016
 
Long-term oxygen brought no benefits for moderate hypoxemia in COPD

In patients with COPD with exertional hypoxemia, long-term supplemental oxygen did not improve survival or quality of life in a multicenter randomized trial published in the New England Journal of Medicine. The NIH-funded study calls into question the current practice of routinely treating moderately hypoxemic COPD patients with supplemental oxygen, and the billions spent for it [… read more]

Oct 282016
 
Corticosteroids for sepsis didn't prevent septic shock (HYPRESS trial)

The idea that augmenting cortisol levels to normal or supranormal levels must be somehow beneficial in septic shock has a compelling basis in physiology and intuition. For physicians, injecting powerful synthetic hormones to restore homeostasis to save a dying patient is a seductive fulfillment of the scientist-savior fantasy. So intensivists were primed to believe the results of [… read more]

Oct 202016
 
Mechanical Circulatory Support Devices: What You Need to Know (Part 2 of 2)

The Rise of Mechanical Circulatory Support Devices What Critical Care Physicians Need to Know Felipe Teran-Merino M.D. Part 2 of 2 (read part 1)   II. Main MCS devices used for emergency and short-term support Intra-Aortic Balloon Pump The oldest and simplest mechanical device is the intra-aortic balloon pump (IABP). Introduced in 1968, the IABP is still used as a [… read more]

Oct 202016
 
Mechanical Circulatory Support Devices: What You Need to Know (Part 1 of 2)

The Rise of Mechanical Circulatory Support Devices What Critical Care Physicians Need to Know Felipe Teran-Merino M.D. Part 1 of 2 (read part 2)   I. The failing pump and hemodynamic rationale for the use of MCS devices The rising field of mechanical circulatory support (MCS) offers a spectrum of therapies and devices with the potential to rescue patients [… read more]

Jun 102016
 
Call for Abstracts: Pittsburgh-Munich International Lung Conference

Have you submitted your abstract to the 2016 Pittsburgh – Munich International Lung Conference? Concurrent submissions are accepted!  Use the abstracts you have submitted this spring for other national/international conferences (i.e. ATS) for a chance to further showcase your work.  Click on the links below to begin. The 2016 Pittsburgh – Munich International Lung Conference [… read more]

Sep 172015
 
Overdiagnosis of pulmonary embolism on CT-angiogram by radiologists may be widespread

Contrasted CT-angiography of the chest, often called a “PE protocol CT,” has dramatically improved the diagnosis of pulmonary embolism. When used in conjunction with validated clinical decision tools like modified Wells criteria, CT-angiography is highly sensitive (good at detecting PE when it’s there and ruling it out when it’s not) and specific (generating few false-positive [… read more]

Aug 272015
 
Limited cancer screening seems appropriate after unprovoked PE

Cancers can cause pulmonary embolism, and an unprovoked PE may signal an undiscovered cancer lurking in the body. In older studies, as many as 1 in 10 patients with unprovoked PE were diagnosed with cancer within a year. (The current terminology is that a PE is provoked if associated with a known cancer or another provoking factor, but [… read more]

Aug 252015
 
Dabigatran-induced bleeding: antidote (idarucizumab) on the way

New oral anticoagulants like dabigatran, apixaban and rivaroxaban have advantages over warfarin: not requiring regular monitoring for efficacy; faster onset of action; shorter half-lives. Unlike warfarin, they’ve had the significant disadvantage of having no proven antidote for the bleeding that inevitably occurs when any anticoagulant is given to thousands of people. [lawsuits] Boehringer Ingelheim, makers [… read more]

Aug 252015
 
Are central lines really needed for vasopressor infusions?

image: Wikipedia There’s only one sure way to prevent complications from a central line: don’t place one. Like many invasive interventions, some of central venous catheters’ indications have been called into question in recent years. Monitoring of central venous pressure and central venous oxygen saturation via central IV access — once considered essential to good care [… read more]

Aug 232015
 
2015 ATS Guidelines on Treatment of IPF Released

ATS Releases New Idiopathic Pulmonary Fibrosis Treatment Guidelines Recent Studies Bring New Recommendations by Lekshmi Santhosh, MD This month, the American Thoracic Society, European Respiratory Society, Japanese Respiratory Society and Latin American Thoracic Association released their updated guidelines on the treatment of idiopathic pulmonary fibrosis (IPF). They are free on the ATS website for all to peruse, but [… read more]

Jul 172015
 
Recurrent PE risk after long-term warfarin therapy remains high (PADIS-PE)

Not long ago, doctors were taught that 6 months of anticoagulation was plenty for patients with unprovoked pulmonary embolism. That standard was never based on long-term outcomes studies. And as longer-range data started to come in — gulp — it was clear that large numbers of people treated with 6-month warfarin courses after unprovoked PE [… read more]