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]
Nighttime Intensivist Staffing Does Not Help (Again) As I’ve said before, probably past the point of being annoying, we intensivists perform a vital service for humanity — just ask us. Numerous studies have concluded that a specialized intensivist’s presence in an intensive care unit during the day saves lives and results in better use of health [… read more]
Biomarkers Predict COPD Exacerbations (Sort Of) In addition to daily breathlessness, people with chronic obstructive pulmonary disease (COPD) often experience exacerbations of shortness of breath and coughing. Those with more severe COPD tend to have more frequent and severe exacerbations, lower enjoyment of life, and more rapid loss of lung function. The strongest predictor of [… read more]
Early Parenteral Nutrition (TPN) Didn’t Save Lives Under the high stress of critical illness, people lose fat and muscle quickly. Obesity appears to be protective during critical illness, possibly because those extra fat reserves come in handy during this period of accelerated catabolism. The strong physiological rationale and the psychological pressure not to appear to be [… read more]
EUS with EBUS Superior at Diagnosing Sarcoidosis Sarcoidosis affects tens of thousands of people in the U.S., but making the diagnosis can be tricky. A biopsy is almost always required, and since >90% of patients have involvement of the lungs and/or lymph nodes in the chest, bronchoscopy has been the standard procedure for obtaining tissue. [… read more]
For COPD Exacerbations, 5 Days Corticosteroids As Good as 2+ Weeks COPD exacerbations — worsening of shortness of breath and cough, often requiring medical treatment — are a major problem for many people living with COPD. People with moderate or severe emphysema and chronic bronchitis (together called chronic obstructive pulmonary disease) experience an average of [… read more]
image: cancer.gov Patients With Metastatic Lung Cancer Often Believe Radiation Could Cure Among 384 patients with metastatic lung cancer who answered a survey, two in five expressed belief that radiation therapy was “very likely” or “somewhat likely” to cure them. Eighty percent thought radiation therapy would allow them to live longer, and only one-third admitted [… read more]
image: CUHK Early Tracheostomy Does Not Help in Large “TracMan” Trial More than 100,000 tracheostomies are performed worldwide each year for people requiring prolonged periods of mechanical ventilation. It’s generally agreed that to avoid damaging the trachea and throat, a tracheostomy should be placed within 3 weeks of mechanical ventilation. But prior to 3 weeks, [… read more]
U.S. FDA Advises Against Hetastarch Use in ICU European Agency Recommends Ban It was probably only a matter of time. In the wake of large randomized trials suggesting hydroxyethyl starches (HES or hetastarch) cause kidney injury and death in critically ill patients from sepsis and other causes, and the European Medicines Agency formally suggesting this month [… read more]
image: Wikipedia Rapid Blood Pressure Control Doesn’t Hurt, May Help in Intracerebral Hemorrhage Strokes caused by intracerebral hemorrhage — sudden bleeding into the brain — are as devastating as they sound. Almost half of people with intracerebral hemorrhage (ICH) die within a month, and most of the survivors end up in nursing homes or needing [… read more]
Getting Sick at High Altitude: Prevention & Treatment Rapidly ascending above altitudes of 8,200 feet (2,500 meters) from lower elevations can result in illness ranging from mild nausea and headaches, to life-threatening edema of the lungs or brain. Truth is, there is little data to help physicians prevent or treat high-altitude illnesses, or to counsel [… read more]
“Decolonizing” New ICU Patients Reduces Bloodstream Infections: NEJM This article had an erratum posted in NEJM: read more here. In humankind’s battle against bacteria, the ICU is the front line. And with MRSA infection rates doubling in the past 5 years, and the more recent and scary spread of lethal pan-resistant Enterobacteriae, lately the bugs have [… read more]
Ultrasound Case 1 Hypotension after a Cholecystectomy: Why? From Philippe Rola and the Critical Care & Ultrasound Institute, the first in a series of educational ultrasound cases on PulmCCM: A 64 year-old male is admitted to the ICU from the surgical ward with hypotension, 3 days post-cholecystectomy. He is intubated for airway protection following loss [… read more]
By Dr. Philippe Rola I was recently scanning the literature in preparation for our symposium, and came across what should have been a 2003 instead of a 2013 publication in the March issue of the CCM Journal, entitled “Point-of-Care Ultrasound to estimate Central Venous Pressure: A Comparison of Three Techniques.” I have to admit this [… read more]
Managing Anticoagulation Therapy For Surgery and Procedures See also: How to manage anticoagulation perioperatively (ACCP Guidelines) NOTE: Please read the Terms of Use before proceeding. If you are a patient, stop reading now; this site is for health care professionals only. If you are a health care professional, do not rely on this information as [… read more]
image: Olympus EBUS Complication Rates <1% at Experienced Centers Endobronchial ultrasound (EBUS) — an ultrasound probe on the tip of a bronchoscope — allows real-time viewing of tissues beyond the bronchial wall. It enables more accurate and safer needle biopsies of lymph nodes and masses that abut the bronchial wall. EBUS is an exciting new [… read more]
Prone Positioning Saves Lives in Severe ARDS Patients: NEJM It’s long been known that positioning patients with ARDS on mechanical ventilation face-down (prone) improves their oxygenation. (There are various theories why prone positioning helps, such as by reducing ARDS’s injurious heterogeneous alveolar overdistension.) The improved oxygen levels have never translated into improved outcomes in ARDS [… read more]
How to Prevent Acute COPD Exacerbations Acute exacerbations of chronic obstructive pulmonary disease (COPD) are a major problem for many people living with COPD. Acute exacerbations or attacks occur more often in people with more severe COPD (about 1-2 per year), and these disease flares may either signal or cause a more rapid progression of [… read more]
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