Acute Liver Failure: Treatment (Part 2 of 2) See also: Acute Liver Failure: Causes & Initial Management Management of acute liver failure is largely supportive critical care for the multiorgan failure that frequently results. Severe acute liver failure results in rapidly progressive hepatic encephalopathy and lethal cerebral edema; this complication requires special vigilance and expert [… read more]
Best of 2013 in PulmCCM (Part 2) Read Part 1 2013 brought us a bumper crop of interesting and useful journal articles. No one could read them all, much less review them, but we at PulmCCM did our best. Here are the ones we found most worth your time. Happy New Year from PulmCCM, and [… read more]
Best of 2013 (1 of 2) Read Part 2 As we wave goodbye to 2013, take another look at the studies that got people thinking and talking this past year. New posts will resume January 6 in the new year. Happy and safe holidays to all, and thanks for visiting PulmCCM in 2013! High frequency [… read more]
Low-dose CT screening reduced death from lung cancer by about 20% in the National Lung Screening Trial, and the U.S. Preventive Services Task Force signaled it would recommend CT screening for most people with a heavy smoking history. The Affordable Care Act stipulates that USPSTF-recommended screening tests be completely free to consumers, so lung cancer screening will [… read more]
The Glycocalyx: An Overview for the Clinician. by Dr. Phillipe Rola Ok, so I’d had a couple of glimpses at articles in the past few years which referred to the glycocalyx, but, in truth, I tend to read most of the “bench” studies a little, well…quickly. So basically, when I listened to Paul’s (Marik) recent lecture at [… read more]
The American College of Physicians released a new clinical practice guideline for the management of obstructive sleep apnea, published in Annals of Internal Medicine. ACP advises people with obstructive sleep apnea should use CPAP therapy or other airway opening devices such as mandibular advancement devices, and should be encouraged and assisted in losing weight. The guideline was [… read more]
Prevention and Management of Ventilator-Induced Lung Injury See also Part 1: Mechanisms of Ventilator-Induced Lung Injury The recognition that lifesaving mechanical ventilation can also be harmful, even lethal, has led to a sea change in the use of mechanical ventilation in critically ill patients — at least in theory. For people with acute respiratory distress [… read more]
Mechanisms of Ventilator-Induced Lung Injury (Part 1) See also Part 2: Prevention and Management of Ventilator-Induced Lung Injury Although invasive mechanical ventilation saves tens of thousands of lives each year, it can also be harmful, causing or worsening acute respiratory distress syndrome (ARDS) when misapplied. The repetitive stretching of lung tissue during positive pressure ventilation [… read more]
So, your patient’s in shock: quick, give some fluids. But colloids or crystalloids? How to choose? They both raise blood pressure, they both improve organ perfusion — but one’s less filling, the other tastes great (what, you haven’t tried them?). It’s no wonder the question makes your head hurt; the evidence base is a jumble. The [… read more]
Most people with obstructive sleep apnea (OSA) have high blood pressure (hypertension), but treating OSA with continuous positive airway pressure (CPAP) has been shown to reduce blood pressure only minimally (by about 2.5 mm Hg). A randomized trial in the November 2013 Chest suggests that in people with severe drug-resistant hypertension with OSA, CPAP can [… read more]
No Improvement in Cardiac Arrest Outcomes With Hypothermia Therapeutic hypothermia, or targeted temperature management, has become a standard component of post-cardiac arrest care. The evidence supporting this practice came from two small-to-medium-sized randomized trials, both published in the New England Journal of Medicine in 2002: Among 273 patients with out-of-hospital cardiac arrest due to shockable [… read more]
Is Idiopathic Pulmonary Fibrosis Caused by a Virus? The cause(s) of idiopathic pulmonary fibrosis have vexed researchers for decades. Although risk factors (smoking, familial gene mutations) provide clues, the actual trigger for the proliferative, fibrotic cellular process resulting in usual interstitial pneumonitis (on biopsy specimens) and IPF (clinically) have remained frustratingly elusive. But an exciting [… read more]
Shock Review (Part 1 of 2) (See also Shock Review Part 2: Goals of Therapy) Jean-Louis Vincent, editor in chief of Critical Care, has a new review article on circulatory shock in the New England Journal of Medicine, where he’s also the editor of their new critical care section. Daniel De Backer co-authors. (See also [… read more]
Shock Review (Part 2 of 2) (See also Shock Review Part 1: Mechanisms and Therapies) Shock results from serious illness compromising either vascular muscle tone (most commonly septic shock), the heart’s function, or the volume of plasma inside blood vessels. The true goal of treatment for shock is to correct the underlying cause, but except [… read more]
Statins have anti-inflammatory and immune-modulating effects, and among critically ill patients, continuing or starting statins have improved soft outcomes in observational and small randomized studies. For example, starting a statin reduced progression of sepsis in ward patients and statins improved organ failure scores in acute lung injury (the HARP trial). But in their first shot at [… read more]
In early 2012, PulmCCM breathlessly reported the results of a New England Journal of Medicine (NEJM) paper by Surenda K. Sharma et al, claiming to show that continuous positive airway pressure (CPAP) can reverse metabolic syndrome (obesity, dyslipidemia, and insulin resistance). Whoops. The authors retracted the article after keen-eyed academics smelled something fishy and asked [… read more]
Diagnosing lung cancer without a biopsy may seem like science fiction, but breath testing to identify lung cancer has made steady gains in accuracy in recent years. A study abstract presented by Peter Mazzone et al at Chest 2013 in Chicago shows just how far one of the new technologies — volatile organic compound analysis [… read more]
Olodaterol Olodaterol, a new once-daily inhaled long-acting beta agonist, improved lung function and exercise capacity in chronic obstructive pulmonary disease (COPD) in two randomized trials (n=199) presented by Gregory Feldman et al at the Chest 2013 meeting in Chicago. The new once-daily LABA olodaterol will reportedly be marketed by Boehringer Ingelheim under the trade name Striverdi [… read more]
Breo Ellipta (GlaxoSmithKline) is the first FDA-approved combination product with a once-daily long acting beta agonist (vilanterol) and inhaled corticosteroid (fluticasone). Additional once daily combination ICS/LABA and LABA/antimuscarinics are expected to launch over the next decade, increasing the options for treatment of asthma and COPD. GSK got good news in the October Chest, with the publication [… read more]
Once-daily long-acting beta agonist indacaterol (Arcapta Neohaler) went head to head against tiotropium (Spiriva) in a randomized trial among 3,444 patients with severe COPD, funded by indacaterol makers Novartis. Indacaterol, approved in 2011 as a treatment for COPD, was deemed noninferior to tiotropium according to the prespecified criteria of the trial, bronchodilating almost identically (a [… read more]
Get PulmCCM’s Weekly Email Update
Stay up-to-date in pulmonary and critical care. No spam.