Parra et al diagnosed OSA in 140 patients hospitalized for stroke in Spain and randomized them to nasal auto-titrating CPAP or no therapy. The CPAP-treated patients had better Rankin and Canadian stroke outcome scores at all follow-up visits. They had the same rate of subsequent cardiovascular events, but events occurred at a median 15 months [… read more]
Rubboli et al summarize the (weak) evidence and current guidelines. General avoidance of drug-eluting stents in those with need of long-term warfarin is still the party-line recommendation, with triple therapy (warfarin, aspirin, clopidogrel) for those who receive a DES due to a strong indication. While TT is clearly superior for high risk patients (e.g., mechanical valve), the [… read more]
Dabigatran, a new oral thrombin inhibitor : Hankey GJ, Circulation 2011;123:1436-1450.
Intracerebral hemorrhage, acute management of: Flower O, Curr Opin Crit Care 2011;17:106-114.
Trouillet et al randomized patients requiring mechanical ventilation 4 days after cardiac surgery to either immediate perc-trach, or delayed percutaneous tracheostomy at 15 days. There were no differences in ventilator-free days at 60 days, nor in survival at 28, 60, or 90 days, nor in rates of VAP; however, the early-trach group had a lower [… read more]
Post cardiac arrest syndrome: Review of therapies: Stub D, Circulation 2011;123:1428-1435.
Subarachnoid hemorrhage, critical care of: Wartenburg KE, Curr Opin Crit Care 2011;17:85-93.
Tako-tsubo cardiomyopathy, natural history of: Parodi G et al, CHEST 2011;139:887-892.
Depriving young and old adults (n=16) of sleep for 24 hours, Robillard et al report that the elderly (mean 64 years) had increased systolic blood pressure and orthostasis, compared to the young people. Sleep 2011;34:online.
The EMShockNet team previously claimed in JAMA that hyperoxia (paO2>300) after cardiac arrest could be deadly (63% in-hospital mortality vs 45% in normoxic patients). After looking at 12,108 database records in Australia/New Zealand, Bellomo et al beg to differ. By applying severity of illness/propensity models, they found no increased risk of death in those with [… read more]
As Andy Rooney might say, “With all the diagnoses doctors like to make these days, didjever wonder if anyone is actually healthy anymore?” When it comes to heart health, according to Bambs et al, the answer is yes: one person is. Circulation 2011;123:850-857.
Critical care for patients with stroke. Lukovits TG, CHEST 2011;139:694-700.
Warfarin is the best drug for stroke prevention in atrial fibrillation. In people with a-fib for whom warfarin was unsuitable (unstable INR, unlikely adherence, etc, but excluding those with prior bleeding on warfarin), twice daily oral direct Xa inhibitor apixaban had a hazard ratio of 0.45 over aspirin for the primary outcome of stroke (absolute [… read more]
How “hard” should we “hit” our patients with Lasix? And does that hurt? Felker et al asked that (sort of) in a NHLBI-funded trial. They gave furosemide to 308 patients hospitalized for ADHF in an IV dose either equivalent to their home dose, or at 2.5 times their home dose, and either at q12-hour intervals [… read more]
Cardiopulmonary exercise testing in people with heart and lung disease: Arena R, Circulation 2011;123:668-680.
Using Medicare records from more than 30,000 beneficiaries with congestive heart failure, Javaheri et al suggest in this observational epidemiologic study that sleep apnea may be woefully overlooked and undertreated in people with CHF. The 2% of the cohort who were tested and treated for sleep apnea had one-third the 2-year mortality of their risk-matched [… read more]