Use of C-reactive protein (CRP) in decision-making may reduce antibiotic use in COPD exacerbations, but not as a replacement for clinical judgment, a study suggested. Chronic obstructive pulmonary disease (COPD) exacerbations are characterized by increased inflammation in the airways and the body generally. C-reactive protein (CRP) is a serum test for inflammation, and has been [… read more]
by Molly Walker, Associate Editor, MedPage Today If you want an accurate reading from sepsis patients’ blood cultures, don’t start antibiotics until you’ve drawn the blood samples, a new study suggested. Among patients with severe sepsis, blood cultures taken prior to antibiotic therapy were positive for one or more microbial pathogens in 31.4% of patients [… read more]
Vitamin C infusion has generated tremendous interest as an adjunctive treatment for patients with sepsis, since a widely publicized cohort study claimed vitamin C dramatically reduced sepsis-related mortality at a single institution. The publicity, the plausible pathophysiologic mechanism, and the lack of any therapy for sepsis have led many intensivists to prescribe the so-called Marik [… read more]
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “Better never means better for everyone… It always means worse, for some.” -Margaret Atwood Case A 73-year-old woman with a history of severe chronic bronchitis, ESRD receiving thrice-weekly hemodialysis and heart failure with a preserved ejection fraction is admitted from home with fevers, [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “I’ve looked at clouds from both sides now …” -Joni Mitchell Background In a recent physiological study – brought to my attention by the erudite and kinetic [@iceman_ex] – the detailed physiological effects of intravenous fluids, norepinephrine and dobutamine were sequentially evaluated in patients with sepsis. Sepsis was defined as [… read more]
“Nihilist” is one of the harshest insults that can be lobbed at a physician. Even while one knows intellectually that every patient can’t be saved, it’s considered odious to openly acknowledge that actuarial reality. Accepting the truth that some patients will inevitably die despite our best efforts is seen by some as the threshold of [… read more]
Guidelines advise physicians give large boluses of intravenous crystalloid infusions (two to three liters, generally) to patients with septic shock. Vasopressors are typically begun only if patients’ blood pressure remains low after fluid administration. A vocal minority of researchers have advised against delaying vasopressors in septic shock, arguing that norepinephrine, not intravenous fluid, is the [… read more]
by Molly Walker, Staff Writer, MedPage Today Omadacycline, a novel antibiotic in the tetracycline class, was non-inferior to standard of care for both community-acquired bacterial pneumonia and acute bacterial skin and skin-structure infections, two randomized trials found. There was no significant difference in early clinical response among patients with community-acquired bacterial pneumonia randomized to omadacycline and those [… 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]
by Salynn Boyles, Contributing Writer, MedPage Today Treatment with antibiotics during hospitalization for asthma exacerbation was associated with longer hospital stays and higher hospital costs in a retrospective cohort study of nearly 20,000 adult patients. Mihaela Stefan, MD, PhD, of the University of Massachusetts Medical School in Springfield, and colleagues, found that despite guidelines recommending against routine [… 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]
The U.S. Food and Drug Administration (FDA) approved baloxavir marboxil, an oral tablet to be marketed as Xofluza, for treatment of early acute uncomplicated influenza in adolescents and adults. FDA Commissioner Scott Gottlieb said in a news release, This is the first new antiviral flu treatment with a novel mechanism of action approved by the FDA [… 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]
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]
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]
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]
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]
Fluoroquinolone warning labels keep getting longer. In 2018 the U.S. FDA ordered stronger cautions about mental health side effects, and severe hypoglycemia causing coma and death. Mental health disturbances now attributed to fluoroquinolones include: Attention disturbances Disorientation Agitation Nervousness Short-term memory loss Delirium The risk of hypoglycemic coma now gets a specific mention on the [… read more]
Obese people are significantly more likely to survive severe illness due to infections, as compared to people with normal weights, according to analyses of three large data sets presented at a European conference. Among more than 1.5 million hospitalizations for pneumonia in the U.S. between 2013-2014, obese patients (BMI > 30) were 29% more likely [… read more]
Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M Canepa MD [@_carlemd_] “I’ve never known any trouble than an hour’s reading didn’t assuage.” -Schopenhauer The last few decades have infamously boasted numerous failed therapies for sepsis and septic shock. Because sepsis represents an explosive and chaotic cacophony of pro and anti-inflammatory mediators – treatments which [… read more]
Get PulmCCM’s Weekly Email Update
Stay up-to-date in pulmonary and critical care. No spam.