Vasopressors for Septic Shock (from the Surviving Sepsis Guidelines) See more from Surviving Sepsis Guidelines* *PulmCCM is not affiliated with the Surviving Sepsis Campaign. Vasopressors are provided for septic shock that does not respond to fluid resuscitation. Norepinephrine (Levophed), epinephrine, vasopressin, phenylephrine (Neo-Synephrine), and dopamine are the most commonly used vasopressors for septic shock. To achieve adequate fluid [… read more]
Weight Gain After Quitting Smoking Usually Mild, Harmless Nicotine is an anorexigen, or appetite suppressant. This “benefit” of cigarette smoking is no secret, certainly not to teenage girls, who in surveys report smoking to stay thin. Even among women smokers over age 40, more than half said they would not quit smoking if it meant they would [… read more]
We are quickly approaching the 2013 Pittsburgh International Lung Conference on October 17-18, 2013. The theme, “Acute and Chronic Lung Infections: Novel Pathogens, Diagnostics, and Therapeutics aims to describe and discuss the latest clinical and research advances as they apply to respiratory infections by bringing together leading regional, national, and international experts in the field. [… read more]
Ultrasound Case 2 A 64 year-old man has tachycardia and dyspnea. Why? See All Ultrasound Cases You are called late at night by the surgical ward to the bedside of a 64 year-old male who is post-op day 2 for reversal of an ileostomy, following a right hemicolectomy for colon cancer 6 months previously. He [… read more]
Following “Surviving Sepsis” Guidelines Not Always the Best Care By Dr. Philippe Rola First of all, I would like to commend those involved in the Surviving Sepsis Campaign’s Guidelines. It is a tremendous endeavour that, without a doubt, has heightened awareness and their growing implementation has and will save many lives. I would, however, also [… read more]
Surviving Sepsis Guidelines 2013 Review & Update The Surviving Sepsis Campaign launched in 2002 as a collaboration between the Society of Critical Care Medicine and the European Society of Intensive Care Medicine, with the shared goal of reducing deaths from sepsis and septic shock around the world. PulmCCM is not affiliated with the Surviving Sepsis Campaign. [… read more]
Diagnosis of Severe Sepsis and Septic Shock (from the Surviving Sepsis Guidelines) See all the Surviving Sepsis Guidelines* *PulmCCM is not affiliated with the Surviving Sepsis Campaign. Sepsis is defined as an infection (definite or suspected) with systemic manifestations (any 2 from a list). This definition may seem overly broad — it means that many [… read more]
Initial Volume Resuscitation and EGDT for Severe Sepsis/Septic Shock See all the Surviving Sepsis Guidelines* *PulmCCM is not affiliated with the Surviving Sepsis Campaign. An approach including early goal directed therapy with aggressive initial fluid resuscitation has been considered a cornerstone of initial therapy for severe sepsis and septic shock, since a single-center randomized trial [… read more]
Initial Antibiotic / Antimicrobial Therapy in Severe Sepsis/Septic Shock For Sepsis, Use the Right Antibiotics at the Right Time (= As Early As Possible) See all the Surviving Sepsis Guidelines* *PulmCCM is not affiliated with the Surviving Sepsis Campaign. The short version: Give appropriate and effective antibiotics as early as possible for patients known or [… read more]
Diagnosis of Asthma: Review & Update Asthma is a poorly understood disease characterized by chronic inflammation of the airways (bronchi and bronchioles). This inflammation causes periodic constriction of the airways in people with asthma, with shortness of breath, wheezing, and coughing that is often worse at night or early in the morning. Asthma is thought [… read more]
More Children Under 12 to Be Considered for Adult Lung Transplants The Organ Procurement and Transplantation Network (OPTN), which is responsible for the life-and-death policies for allocation of lung transplants and other organs, announced it will allow children needing lung transplants to file expedited appeals to be listed for adult lungs. Children under 12 with [… read more]
Adding Vasopressin, Steroids to Epinephrine Improved Cardiac Arrest Outcomes Contrary to what watching TV or even reading the newspaper will lead one to believe, outcomes after in-hospital cardiac arrest are very poor. Only about 1 in 5 survive to leave the hospital after cardiac arrest, and most survivors suffer significant cognitive impairment; up to half suffer [… read more]
Management of Lung Cancer in High Surgical Risk Patients By Blair Westerly, MD We all hope that surgical resection is an option for our unfortunate patients diagnosed with lung cancer. However, as a consequence of the epidemiology of stage I non-small cell lung cancer, the standard of care, lobectomy with systematic mediastinal lymph node evaluation, [… read more]
Low Tidal Volume Ventilation Improves Outcomes in Elective Surgery Using low tidal volumes (6-8 mL/kg ideal body weight, or about 500 mL in the average man) during mechanical ventilation has been known for more than a decade to be lifesaving for people with acute respiratory distress syndrome (ARDS). Since reducing mortality by a relative 22% [… read more]
USPSTF Endorses Lung Cancer Screening CT; New Standard of Care Begins Lung cancer screening CT took its most important step toward widespread implementation last week, when the U.S. Preventive Services Task Force (USPSTF) released a draft of its forthcoming recommendation that the 9 million U.S. people meeting entry criteria for the National Lung Screening Trial [… read more]
image: Vitacost N-acetylcysteine (NAC) Improves COPD Outcomes Oxidative stress (imbalance between oxidants and antioxidants) is part of the story of how COPD causes symptoms of cough and shortness of breath. Cigarette smoke is the main source of oxidation damage in the lungs leading to COPD, but even after they quit smoking, people with COPD still [… read more]
New Pulmonary Hypertension Drug Riociguat Proves Effective Pulmonary arterial hypertension is a rare but life-threatening illness affecting around 10,000 people in the U.S., in which ongoing remodeling of the pulmonary vasculature leads to narrowed pulmonary arteries with increased pulmonary artery pressure (pulmonary hypertension), and if untreated, eventual right heart failure and death. (The overwhelming majority [… read more]
Riociguat Improves Chronic Thromboembolic Pulmonary Hypertension (CTEPH): CHEST-1 Chronic thromboembolic pulmonary hypertension (CTEPH) is an uncommon complication of pulmonary embolism, in which the pulmonary blood vessels become occluded by the body’s ongoing reaction to residual blood clots. The result is slowly worsening shortness of breath, pulmonary hypertension, and eventually right heart failure. People with chronic [… read more]
Restrict Lung Cancer Screening CT To Highest-Risk People? The National Lung Screening Trial showed that 3 annual low-dose chest CT scans in people with heavy smoking histories (30+ pack-years) saved lives, reducing the risk of death from lung cancer by a relative 20% compared to screening with annual chest X-rays. With 160,000 lung cancer deaths [… read more]
Obstructive Sleep Apnea and Perioperative Complications: A Review Obstructive sleep apnea and other sleep disorders may affect as many as 70 million U.S. adults — 1 in 4 men and 1 in 10 women. People with obstructive sleep apnea are usually obese, have other medical conditions, and are more likely to undergo surgery than people [… read more]
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