The PulmCCM Roundup gathers all the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Statins Fail for COPD, ARDS Statins have been optimistically tested as a tonic for everything from diabetes to dementia — so far, without success. That consistency was maintained in 2 recent trials showing statins’ [… read more]
image: EM Ultrasonography ICU Physiology in 1,000 Words: “Inspiratory collapse of the inferior vena cava: What is it telling us?” Jon-Emile S. Kenny M.D. With the dissemination of small, portable, ultrasound devices [or SPUDs], it seems that it is every house-officer’s dream to own the ability and wherewithal to place an ultrasound probe on a [… read more]
Image: Rotoprone Acute respiratory distress syndrome (ARDS) injures the lungs in a heterogeneous pattern, and the damaged areas are particularly vulnerable to further ventilator-induced lung injury. This is why a lung-protective ventilator strategy using low tidal volumes reduces mortality from ARDS, experts believe. Tidal volumes of 6 mL/kg ideal body weight (calculated from height) using conventional [… read more]
Using BAL Cellular Analysis in Interstitial Lung Disease The role of bronchoalveolar lavage (BAL) in diagnosing and managing patients with interstitial lung disease (ILD) has always been uncertain and controversial. BAL findings are usually nonspecific, suggesting rather than proving the existence of any particular noninfectious condition (including interstitial lung disease). That said, in patients with [… read more]
Azithromycin to Prevent COPD Exacerbations: What’s New? By Abhishek Biswas, MD Multiple previous studies have suggested likely benefits from using azithromycin as an immunomodulator for cystic fibrosis, bronchiectasis, diffuse panbronchiolitis, post-transplant obliterative bronchiolitis and COPD. This month, a new Cochrane analysis and clinical review in JAMA concludes that “continuous macrolide antibiotic use for prophylaxis [is] associated with a [… read more]
About half of people diagnosed with obstructive sleep apnea (OSA) can’t or won’t use the most effective therapy, overnight continuous positive airway pressure (CPAP). Most people with untreated OSA experience multiple episodes of hypoxemia — sometimes hundreds per night. For many patients declining CPAP treatment, their doctors provide overnight oxygen, in the hope that it might [… read more]
All the best in pulmonary and critical care from around the web. Browse all the PulmCCM Roundups. Asthma Childhood obesity increases the risk for asthma, and obesity is also strongly associated with asthma in adults. The mechanisms are likely multiple, complex and interdependent (pro-inflammatory mediators, etc.), not simply causative. Losing weight does seem to improve [… read more]
By Parth Rali, MD and Marvin Balaan, MD Submassive pulmonary emboli (PE) are those that are severe enough to produce right ventricular dysfunction on echocardiogram or elevated biomarkers (mainly troponin), but not hemodynamic instability (i.e., systemic blood pressure and cardiac output are preserved). The management of the patient with submassive PE is a matter of controversy with several [… read more]
NAC for IPF: Fail (PANTHER-IPF Wrap-Up) Long ago, when pulmonologists were more ingenuous (in 2000), flawed clinical trials convinced the American Thoracic Society to recommend prednisone and either azathioprine or cyclophosphamide in its consensus guideline for some patients with idiopathic pulmonary fibrosis (IPF). By not including a true control arm, the also-flawed follow-up 2005 IFIGENIA trial reinforced this [… read more]
In 2011 PulmCCM reported the findings of the phase 2 TOMORROW study, showing Boehringer Ingelheim’s tyrosine kinase inhibitor code-named BIBF 1120 reduced lung function decline and prevented exacerbations in people with idiopathic pulmonary fibrosis (IPF). At the 2014 American Thoracic Society annual meeting and in the New England Journal of Medicine, investigators announced their latest [… read more]
For idiopathic pulmonary fibrosis treatment pirfenidone, the third time wasn’t the charm; the fourth was. After reducing decline in forced vital capacity over one year in a Japanese trial of 275 IPF patients, pirfenidone went one-and-one in the multinational CAPACITY trials (n=779), meeting the primary outcome of FVC preservation in one but not the other. [… read more]
The Centers for Medcare and Medcaid Services sent lung cancer screening’s forward momentum into a tailspin last month, when Medicare’s advisory panel shocked observers by voting against covering lung cancer screening with annual low dose chest CT as a standard benefit. The U.S. Preventive Services Task Force (USPSTF) had already recommended lung cancer screening be [… read more]
Nutritional Support During Critical Illness This PulmCCM topic review will be periodically updated and expanded as new research is published. Originally published September 22, 2013. Most recent update: January 24, 2019. During critical illness, catabolism (breakdown of muscle protein, fat and other complex molecules) occurs faster than anabolism (synthesis of these same macromolecules). Historically, the [… read more]
Red Cell Transfusions Increase Risk for Nosocomial Infection: Meta-Analysis Transfusing blood to anemic patients has an almost irresistible intuitive and theoretical appeal both to physicians and the patients who get transfused. It’s perhaps the archetypal example of the “find it – fix it” approach to doctoring: correct all laboratory abnormalities and ipso facto, the patient [… read more]
Image: Inspire Med Systems Hypoglossal Nerve Stimulation for Sleep Apnea Wins FDA Approval The U.S. Food and Drug Administration approved Inspire Medical Systems’ pacemaker-like hypoglossal nerve stimulator for patients with moderate to severe obstructive sleep apnea (OSA) who cannot tolerate continuous positive airway pressure (CPAP). The Inspire device stimulates key airway muscles controlled by the hypoglossal [… read more]
Image: pipingrock.com Can N-acetylcysteine help prevent exacerbations of chronic obstructive pulmonary disease (COPD)? Another randomized trial says yes. N-acetylcysteine, or NAC, is a nutritional supplement with antioxidant and anti-inflammatory properties. After ingestion, N-acetylcysteine is metabolized into glutathione, a key antioxidant with effects throughout the body. In the lungs, glutathione deficiency (common in alcoholics) is linked [… read more]
Source: criticalecho.com Diaphragmatic Ultrasonography to Assess Readiness for Extubation By Muhammad Adrish, MD Weaning a patient from mechanical ventilation is a challenge that intensivists face routinely. Clinical examination and objective measurements like minute ventilation, respiratory rate, maximal inspiratory pressure, and ratio of respiratory rate to tidal volume have all been used with varying reported sensitivity [… read more]
The use of thrombolytics for pulmonary embolism is not controversial — that is, if the PE is massive with hypotension (give thrombolytics) or mild, with normal blood pressure and right ventricular function (don’t give them). It’s the patients with intermediate risk pulmonary emboli — with normal blood pressure but with evidence of right ventricular dysfunction [… read more]
Image: 1800petmeds Systemic steroids in COPD exacerbations requiring ventilator support: Are we treating our patients, or ourselves? By Muhammad Adrish, MD Acute exacerbations of COPD are a major cause of hospitalizations, and are associated with more rapid decline in lung function and reduced survival. Because COPD exacerbations are associated with increased inflammatory responses, corticosteroids have [… read more]
Source: KP Albumin: Better Than Crystalloid in Septic Shock? Human albumin boosts oncotic pressure, and has a number of important biologic functions (protein binding, antioxidant, etc.) that could in theory support the body during critical illness. In the 2004 SAFE study, which tested albumin against crystalloid solutions in ~7,000 critically ill patients of various etiologies, 4% [… read more]
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