The FDA is advising physicians that in post-approval data, 30-day survival rates with Abiomed’s Impella RP right ventricular assist device have been only 17%, compared to 73% in the RECOVER RIGHT study leading to the device’s approval in 2017. There were only 60 patients in the post-approval study, who had significantly worse clinical status at [… read more]
Jon-Emile S. Kenny MD [@heart_lung] The mechanical power applied to the lung is a risk factor for ventilator or ventilation-induced lung injury [VILI] [1-4]. But can the work done to the lung over time be homogenized into a single value? Could different components of the power equation carry different VILI risk beyond their mathematical inequalities [… read more]
Jon-Emile S. Kenny MD [@heart_lung] A few years ago I was intrigued by a new concept in Ventilator-Induced Lung Injury [VILI] – the mechanical power. I employed this paradigm, introduced by Gattinoni’s group, as an opening for the ‘ARDS Trilogy.’ Since then, I have also discussed this ‘ergotrauma’ in the context of helium-oxygen physiology and [… read more]
Proton pump inhibitors (PPIs) are widely prescribed to mechanically ventilated patients to prevent gastrointestinal (GI) bleeding. The evidence for their use is not strong; individual randomized trials have not shown a clear benefit over histamine blockers, but when many trials were pooled into meta-analyses, PPIs do appear to be superior. The Surviving Sepsis Guidelines have [… read more]
(From Dr. Philippe Rola) Join us for a couple of days of awesome learning in an awesome city! Back, bigger and better for its second iteration, this multispecialty cross-training exercise brings you the cutting and bleeding edge of acute care management of the sick patient, from the ED to the wards or the ICU. Combining [… read more]
Stethoscopes have always been an obvious suspect in the transmission of infections to patients by health care professionals. They’re carried room to room, come in contact with each patient, and are almost never disinfected between patient contacts. Testing has shown just what one would expect: stethoscopes are often contaminated with bacteria. One of the latest [… read more]
Most families have never suffered through a loved one experiencing prolonged critical illness and respiratory failure (defined as ventilator dependence for weeks, usually with a tracheostomy). But each year, more do. An estimated 400,000 people currently live with chronic critical illness in long-term acute care hospitals (LTACHs) and other facilities — a population that has [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “The truth is balance, but the opposite of truth, which is unbalance, may not be a lie.” -Susan Sontag Case A 49 year old man presents with two days of hemoptysis, right-sided pleuritic chest pain and a few hours of ‘confusion’ according to his teammate in a pick-up hockey league. One [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “Nolite te bastardes carborundorum” -Margaret Atwood Case An 86 year old woman presents with two days of decreased intake by mouth and 3 days of melena and vomiting. She is followed closely by her internist and cardiologist for hypertension, severe mitral regurgitation, pulmonary venous hypertension and right ventricular dysfunction with co-morbid [… read more]
After a review of reported adverse events, the U.S. FDA is warning physicians that fluoroquinolone antibiotics may increase the occurrence of aortic dissections, resulting in aortic rupture and death. FDA used unusually direct language in advising, “Fluoroquinolones should not be used in patients at increased risk unless there are no other treatment options available.” Patients [… read more]
Pressing fingers against the cricoid cartilage (the Sellick maneuver) during rapid sequence intubation compresses the esophagus beneath the firmer trachea. It has long been espoused that this prevents aspiration (emesis or reflux of gastric contents into the supraglottic space and airway, obscuring the operator’s view and harming the patient). The Sellick maneuver is believed to [… read more]
Tennessee law enforcement agents announced they had arrested and charged a nurse with reckless homicide and patient abuse for a fatal medication error she allegedly committed while working at Vanderbilt University Medical Center in December 2017. The charges allege that the nurse intended to provide an ordered dose of midazolam (Versed) to an anxious patient [… read more]
A large proportion of patients who remain in ICUs for more than a few days develop hospital-acquired infections, including bloodstream infections. Indwelling urinary or venous catheters, gut translocation, aspiration and impaired host defenses can all be causative. Bloodstream infection incidence has been reduced over time, but remains persistently ineradicable. One enticing method of prevention has been [… read more]
Jon-Emile S. Kenny MD [@heart_lung] Why is blood pressure measured by units of length [i.e. millimeters of mercury – mmHg]? What decides systolic and diastolic pressure? What are the determinants of tissue perfusion and what are the clinical implications of this physiology? Can we deceive ourselves into thinking a particular mean arterial pressure [MAP] is [… read more]
By Nicholas Mark, MD During the 1940s, many Melanesian cultures were profoundly altered as the Second World War was waged in the Pacific around them. Western soldiers constructed airstrips out of the jungles and the natives witnessed vast wealth in the form of manufactured goods literally rain down from the skies on parachutes or carried [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “I’m burnin’ through the sky, yeah Two hundred degrees, That’s why they call me Mister Fahrenheit” -Freddie Mercury Part 1 gave a brief overview of the mechanisms of atrial fibrillation [AF] as well as pertinent features of rate controlling agents and anticoagulation. In this brief second part, nuanced features of ventricular [… read more]
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “The habit of writing for my eye is good practice. It loosens the ligaments.” ― Virginia Woolf Case A 28 year old woman with known severe mitral stenosis from rheumatic heart disease presents with acute onset shortness of breath. Her acute dyspnea began while [… read more]
In an unusual turn, the Society for Critical Care Medicine (SCCM) is advising against implementation of the one-hour sepsis bundle originally advocated in Spring 2018 by committee members of its Surviving Sepsis Campaign. SCCM and American College of Emergency Physicians (ACEP) issued a joint statement in which they acknowledged “concerns expressed about the recently released Surviving [… read more]
For acutely ill patients, oxygen saturation should not exceed 96%, an international panel recommended. A multidisciplinary team of clinicians was brought together by The BMJ as part of the Rapid Recommendation initiative to focus on the most effective approach to oxygen therapy for patients with acute medical illness. The team used findings from an April 2018 systematic [… read more]
Best of 2018: Prone positioning for severe ARDS advised by major societies 2018 Update to Surviving Sepsis Guidelines: Cue Backlash Management of Ground Glass and Subsolid Pulmonary Nodules: Review Vasopressors and Inotropes for Shock Syndromes: Review Prophylactic Precedex prevented delirium in ICU patients Corticosteroids do help [… read more]
Get PulmCCM’s Weekly Email Update
Stay up-to-date in pulmonary and critical care. No spam.