PulmCCM

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

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]

Dec 142017
 
Sedation interruptions were even more helpful in surgical patients

Most good medical intensive care units have incorporated interruptions in sedation (so-called ‘sedation vacations’) into standard care for patients receiving mechanical ventilation. Avoiding excessive sedation in general is believed to reduce prolonged mechanical ventilation in ICUs. However, there is surprisingly little data about effects of sedation (or over-sedation) on critically ill postoperative patients in the [… read more]

Dec 132017
 
Real-world bleeding risks of new anticoagulants similar to warfarin (or lower)

New-generation oral anticoagulants (NOACs) like dabigatran, rivaroxaban, and apixaban all had similar efficacy and bleeding risk compared to warfarin in the randomized trials that led to their FDA approval. That didn’t stop trial lawyers from filing bundles of lawsuits on behalf of patients experiencing hemorrhages after taking NOACs. (The large brand-name pharmaceutical manufacturers advertising new [… read more]

Dec 082017
 
Meropenem-vaborbactam (Vabomere), a new combination antibiotic + inhibitor, now available

Intensivists have another antibiotic combination to treat severe infections caused by gram-negative bacteria with the FDA’s approval of Vabomere (meropenem, combined with the beta-lactamase inhibitor called vaborbactam). FDA approved Vabomere only for the treatment of complicated urinary tract infections (such as pyelonephritis). However, licensed U.S. physicians routinely prescribe FDA-approved antibiotics “off-label” for other indications. Meropenem-vaborbactam [… read more]

Dec 082017
 
FDA Approves First Nebulized LAMA for COPD

by Salynn Boyles, Contributing Writer, 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 [… read more]

Dec 012017
 
Should patients watch videos of CPR before code status decisions?

Physicians and patients alike tend to avoid frank discussions about “code status” — whether a patient would want CPR or mechanical ventilation in the event of a cardiac or respiratory arrest. When doctors address code status at all, they tend to phrase the questions in such a way to cut off any thoughtful discussion: “If [… read more]

Nov 192017
 
Oral steroids don't improve cough due to colds (but are prescribed anyway)

Oral corticosteroids are frequently prescribed for persistent cough after the common cold in patients without respiratory disease. Like much of what physicians offer or advise, steroids for ordinary cough are traditionally provided not based on evidence, but on the premise that “it might help.” A new study in JAMA substantially undermines that premise. Authors randomized [… read more]

Nov 192017
 
Should intensivists routinely perform bedside echos in suspected PE?

In pulmonary embolism (PE), right ventricular (RV) strain on transthoracic echocardiography increases the likelihood of shock and mortality. One study showed among patients with PE and normal blood pressure, 10% of those with RV strain on echocardiogram developed shock, and 5% died in hospital. Those without RV strain maintained their blood pressure and survived (but important [… read more]

Nov 112017
 
DIPSHIS in the ICU: An emerging phenomenon?

This would be a very informative case report (and it’s true and unexaggerated), but I anticipate staunch editorial resistance (even sans puns), so I’ll describe it here and have some fun with it. Background:  The author has anecdotally observed for many years that so-called “septic shock” follows rather than precedes intubation and sedation.  This raises [… read more]