(image: Rxhealthdrugs.com) People taking 5 days of azithromycin had a very small absolute increased risk of death, especially due to cardiovascular causes, compared to people taking amoxicillin, in a retrospective cohort review by Wayne Ray, Katherine Murray, and C. Michael Stein published in the May 17 New England Journal of Medicine. Erythromycin and clarithromycin (the other [… read more]
Recombinant human activated protein C or dotrecogin alfa — better known as Xigris, by Eli Lilly — seemed a godsend when it was first approved for treatment of severe sepsis in 2001. Xigris’ FDA approval (despite an evenly split 10-10 vote) was based solely on the Eli Lilly-funded PROWESS study, a phase 3 randomized trial [… read more]
More: Surviving Sepsis Guidelines Review / Update The Surviving Sepsis Campaign is a collaboration between the U.S. Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine, and the International Sepsis Forum, whose recommendations on the management of sepsis are considered widely. At the 2012 SCCM meeting, the Surviving Sepsis committee revealed [… read more]
(image: Wikipedia) In the TIME2 randomized trial published in the June 13 2012 JAMA, indwelling pleural catheters and talc pleurodesis were equivalent at reducing dyspnea over the 6 weeks following the procedure among 106 patients with malignant pleural effusions. Most patients receiving pleural catheters required no hospital stays, and overall had fewer repeat procedures than those [… read more]
Colloids are believed to be more effective expanders of plasma volume than crystalloids, making them a tempting therapy to use for patients in septic shock and other causes of hemodynamic instability. Problem is, some colloid solutions seem to kill people. The VISEP Trial using hydroxyethyl starch 200 kDa/0.5 demonstrated that this high molecular weight HES [… read more]
Linezolid (Zyvox) for XDR-TB: New Hope, New Caution Approved by the FDA in 2000 for drug-resistant gram positive bacterial infections, linezolid (Zyvox, Pfizer) has in clinical practice been mainly used for skin infections and the occasional pneumonia due to methicillin-resistant Staph aureus (MRSA). Now linezolid looks to be effective as an adjunct therapy for multi-drug resistant [… read more]
Does Normal Saline Cause Acute Renal Failure? To internal medicine-trained physicians in the U.S., normal saline solution seems as harmless and healthy as mother’s milk. Intensivists trained in anesthesia or surgery might more often mention normal saline’s hypertonicity compared to blood, and its propensity to cause hyperchloremia, compared to lactated Ringer’s or similar solutions. But [… read more]
Extra Vitamin D Doesn’t Prevent Colds in Healthy Adults (JAMA) It looks like you can add Vitamin D to list of supplements (echinacea, vitamin C, etc.) who’ve gone up against the common cold and lost. (Scorekeepers will note that zinc held its own, though, in a Cochrane analysis.) Vitamin D plays an important role in immune responses, [… read more]
Surviving Sepsis Guidelines’ Criteria for Sepsis Diagnosis See all the Surviving Sepsis Guidelines PulmCCM is not affiliated with the Surviving Sepsis Guidelines or the Surviving Sepsis Campaign which is at http://www.survivingsepsis.org. According to the Surviving Sepsis Guidelines, a sepsis diagnosis requires the presence of infection, which can be proven or suspected, and 2 or more of [… read more]
Have you seen EMCrit.org? It’s the brainchild of Scott Weingart, an ED intensivist in New York City. ED docs like to do things (not just debate and deconstruct them endlessly like us pulmonologist-intensivists). In that spirit, Scott’s site is in my opinion more practical, “virtual-hands-on,” and skills/procedure-based than PulmCCM.org. Here’s a great example — his [… read more]
Physicians who liberally prescribe empiric antibiotics are often maligned as irresponsible or unthinking by condescending colleagues and policy wonks. But are these doctors actually courageous and prudent, saving countless lives every year by refusing to bend to misguided pressure from antibiotic-conserving paper-pushers? As antibiotic resistance has emerged, many hospitals have begun requiring physicians to provide [… read more]
In the first randomized trial of its kind, patients with severe sepsis or septic shock who were given meropenem alone had equivalent clinical outcomes to patients who were given combination therapy including meropenem and moxifloxacin. The results, reported in JAMA, provide ethical support to critical care physicians who prefer to be conservative antibiotic stewards. But [… read more]
If you and your team just can’t get an arterial line into your critically ill, hypotensive patient for continuous invasive blood pressure measurement, you may be somewhat comforted by a study in Critical Care Medicine. Authors found that among 150 critically ill patients (83 of whom were in shock), mean arterial pressure (MAP) measurements with an [… read more]
(image: Wikipedia) Anyone who has ever rounded in an ICU with a nurse manager knows that challenging or questioning the utility of the ventilator associated pneumonia (VAP) bundle is a losing proposition — one likely to get you labeled as a wiseguy troublemaker. Thanks to ventilator bundles’ endorsement by the nonprofit Institute for Healthcare Improvement, [… read more]
This gentleman (not pictured in the photo) graciously allowed himself to be videotaped in the midst of a severe whooping cough episode caused by Bordetella pertussis; the video is posted on the New England Journal’s website. He had not been vaccinated: vaccination during childhood greatly reduces the risk of severe or life-threatening pertussis infection, and reduces [… read more]
by Scott Aberegg, MD, MPH It is rare occasion that one article allows me to review so many aspects of the epistemology of medical evidence, but alas Schortgen et al afforded me that opportunity in the May 15th issue of AJRCCM. The issues raised by this article are so numerous that I shall make subsections for each one. [… read more]
(image: flickrCC) Foam in, foam out, gown on, gown off … ah, the tedium of practicing critical care medicine in the age of rampant, lethal, multi-drug resistant bacteria. As a reminder to keep your guard up and your gear on, here’s a yucky study from Daniel Morgan, Elizabeth Rogawski, and Anthony Harris of the University [… read more]
The CDC announced in its Morbidity and Mortality Weekly Report (MMWR) the sad story of three members of a close-knit Maryland family who all died within days of each other from pneumonia due to seasonal influenza A (H3N2) with methicillin-resistant Staph aureus (MRSA) co-infection. Three additional family members acquired the same influenza A strain (which was [… read more]
Antiviral drugs oseltamivir (Tamiflu) and zanamivir (Relenza) made big bucks for Roche and GSK respectively during the H1N1 influenza pandemic: Roche reportedly sold about $3 billion of Tamiflu in 2009. Although sales have dropped off precipitously, the drugs are still recommended by CDC for serious cases of seasonal influenza. But do Relenza and Tamiflu even [… read more]
Amoxicillin may hasten the recovery from acute sinusitis (sinus infections), with more patients feeling just a tiny bit better after a week of amoxicillin compared to placebo, according to a clinical trial published in the February 15 JAMA. After 10 days, those taking placebo felt as well as those taking antibiotics. You may have heard [… read more]
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