PulmCCM

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

Jun 212013
 
High-Altitude Illness: Prediction, Prevention, Treatment

Getting Sick at High Altitude: Prevention & Treatment Rapidly ascending above altitudes of 8,200 feet (2,500 meters) from lower elevations can result in illness ranging from mild nausea and headaches, to life-threatening edema of the lungs or brain. Truth is, there is little data to help physicians prevent or treat high-altitude illnesses, or to counsel [… read more]

Jun 162013
 
Decontaminate all incoming ICU patients to reduce infections, says RCT

“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [… read more]

Jun 072013
 
Managing anticoagulation for surgery and invasive procedures (Review)

Managing Anticoagulation Therapy For Surgery and Procedures See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: Please read the Terms of Use before proceeding. If you are a patient, stop reading now; this site is for health care professionals only. If you are a health care professional, do not rely on this information as [… read more]

Jun 072013
 
How safe is EBUS? Complication rates <1% at experienced centers

image: Olympus EBUS Complication Rates <1% at Experienced Centers Endobronchial ultrasound (EBUS) — an ultrasound probe on the tip of a bronchoscope — allows real-time viewing of tissues beyond the bronchial wall. It enables more accurate and safer needle biopsies of lymph nodes and masses that abut the bronchial wall. EBUS is an exciting new [… read more]

Jun 022013
 
A turn for the best? Prone positioning saves lives in ARDS trial

Prone Positioning Saves Lives in Severe ARDS Patients: NEJM It’s long been known that positioning patients with ARDS on mechanical ventilation face-down (prone) improves their oxygenation. (There are various theories why prone positioning helps, such as by reducing ARDS’s injurious heterogeneous alveolar overdistension.) The improved oxygen levels have never translated into improved outcomes in ARDS [… read more]

Jun 022013
 
How to prevent COPD exacerbations

How to Prevent Acute COPD Exacerbations Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major problem for many people living with COPD. Acute exacerbations or attacks occur more often in people with more severe COPD (about 1-2 per year), and these disease flares may either signal or cause a more rapid progression of [… read more]

May 252013
 
"Checking residuals" during tube feeding on mechanical ventilation: unnecessary?

No Benefit Seen From Monitoring Gastric Volume in Ventilated Patients on Tube Feedings Early enteral nutrition for patients on mechanical ventilation is considered the standard of care. It’s been assumed that delayed gastric emptying, resulting in a stomach full of liquid nutrition, predisposes patients to have aspiration events and develop ventilator associated pneumonia (VAP). Therefore, [… read more]

May 232013
 
New lung cancer prediction tool promises better use of screening CT

New Prediction Model Selects Best Lung Cancer Screening Candidates In the National Lung Screening Trial (NLST), screening for lung cancer with low-dose chest CT scans resulted in a 20% reduction in death from lung cancer. The consumer-serving American Lung Association recommended outright that older people with heavy smoking histories should get lung cancer screening; leading [… read more]

May 202013
 
Staph vaccine fails in cardiothoracic surgery patients

Staph Vaccine Fails in Cardiothoracic Surgery Patients Staphyloccocus aureus wound infections and bacteremia commonly complicate cardiothoracic surgery, even with meticulous attention to infection prevention. Staph mediastinitis, a deep infection of the surgical wound, is particularly feared and lethal. Vance Fowler et al randomized 8,031 people undergoing sternotomy to receive the V710 vaccine against S. aureus, [… read more]

May 182013
 
Taking Apixaban (Eliquis) after completing Coumadin prevents recurrent DVT/PE

Apixaban (Eliquis) Prevents Recurrent DVT-PE Long-Term People with unprovoked venous thromboembolic disease (pulmonary embolism or deep venous thrombosis, or DVT) are at high risk for recurrence, and current ACCP guidelines advise consideration of “indefinite” anticoagulation. Warfarin (Coumadin) is a wonder drug efficacy-wise, reducing the risk of pulmonary embolism and deep venous thrombosis by ~90%. However, [… read more]

May 162013
 
FDA approves Breo Ellipta, a new once-daily COPD inhaler treatment

FDA Approves Breo Ellipta, Once-Daily LABA/ICS for COPD The FDA approved the new drug Breo Ellipta as a once-daily inhaled therapy for chronic obstructive pulmonary disease (COPD). Breo Ellipta includes the corticosteroid fluticasone, and vilanterol — a once-daily long acting beta agonist — in a combination dry powder inhaler. This was the FDA’s first approval [… read more]

May 122013
 
Killer carbapenem-resistant bacteria spreading through LTACs

Killer Carbapenem-Resistant Bacteria Spreading Across U.S. Gut-living bacteria like Klebsiella are gaining resistance to carbapenems at an alarming rate, and long-term acute care hospitals (LTACs) and nursing homes seem to be the incubators for these killer bugs spreading across the U.S. Carbapenems  like meropenem and doripenem have been the gold standard to treat infections from [… read more]

May 122013
 
Allowing families to witness CPR had positive effects (RCT)

Families Allowed to Witness CPR Felt Better, Had Fewer Regrets Should family members be allowed, or even encouraged, to witness the health care team’s attempts to revive their family member with CPR after a cardiac arrest? In the interests of openness and transparency, many have argued “yes,” with the thought that witnessing the heroic efforts [… read more]

Apr 252013
 
Pulse oximetry as time machine: Lag times confuse doctors, complicate intubations (EMCrit)

image: wikimedia Pulse Oximetry: The 30-Second Time Machine Why does it seem to take so long to re-oxygenate your crashing patient? Because your pulse oximeter is lying to you, no matter how good it is. Telescopes show us how a star looked millions or billions of years ago; pulse oximeters create a similar, though tiny [… read more]

Apr 212013
 
Anti-reflux therapy no help for most with chronic cough

Chronic Cough and Reflux: A Tangled Relationship Although we’re taught that gastroesophageal reflux disease (GERD) is a major cause of chronic cough, the truth may be more complicated, and confusing. A meta-analysis by Peter Kahrilas et al in Chest examining trials of acid-suppressing treatments for chronic cough found no significant benefit of treatment in 7 [… read more]

Apr 172013
 
How dangerous are ground glass nodules over time?

image: Radiology Assistant Ground-Glass Nodules: If Growing, Assume Cancer Blair Westerly, MD The more CT scans that are performed, the more ground-glass opacities (GGO’s) are seen and what to do with these abnormalities can be difficult to ascertain for clinicians. With the National Lung Cancer Screening Trial showing a mortality benefit from low dose CT [… read more]

Apr 122013
 
Inferior vena cava filters: debatable benefit; rarely removed

image: Wikimedia Inferior Vena Cava Filters: What’s the Harm? Do inferior vena cava filters actually create more harm than health? That’s the provocative question being posed by authors and editorialists in JAMA Internal Medicine. Inferior vena cava filters are frequently placed after a pulmonary embolism (PE) or deep venous thrombosis (DVT) in patients with a [… read more]

Apr 112013
 
Obesity may improve survival in ARDS, but with renal failure

In ARDS, Obesity May Protect Life (But Not Kidneys) by Blair Westerly, MD Obesity is an epidemic and common in intensive care units in the United States.  Furthermore, while acute kidney injury (AKI) is also common in critically ill patients, obese patients carry additional risk for AKI because of increased baseline comorbidities. Both obesity and [… read more]

Apr 042013
 
Got sleep apnea? Climbing Everest? Pack your Diamox (RCT)

Acetazolamide Improved Obstructive Sleep Apnea at High Altitudes by Blair Westerly, MD Obstructive sleep apnea (OSA) is common, and so is travel to the mountains for work and play, therefore encounters with patients with OSA who travel to mountain destinations is not infrequent.  We all learn early in training that altitude affects oxygenation, and patients [… read more]