“Set a quit date to stop smoking,” goes the old bit of doctor’s advice. Experts argue people need to psyche themselves up, get serious, commit to quitting before the last butt goes in the ashtray. A new study in JAMA suggests that advice may be outdated. Smokers unready to quit who took the cessation drug varenicline (Chantix) for several months, [… read more]
The U.S. FDA continued its flurry of new antibiotic approvals to close out 2014, giving the nod to ceftolozane with tazobactam. The drug will be marketed as Zerbaxa by the pharmaceutical company Cubist. Ceftolozane is a novel cephalosporin, combined with the existing β-lactamase inhibitor tazobactam in the new product. Zerbaxa has broad activity against gram-negative [… read more]
Medicare will pay for annual low-dose chest CT for lung cancer screening, for former and current heavy smokers between the ages of 55 and 77. The Centers for Medicare and Medicaid Services (CMS) announced the decision last week. CMS had previously signaled they would set the upper age limit at 74, the same as in the National Lung Screening Trial [… read more]
On behalf of the PulmCCM Journal editorial board, it is with great pleasure that I announce the publication of the second issue of PulmCCM Journal, an open-access, peer-reviewed journal in pulmonary and critical care medicine. You can read the new issue online at pulmccm.org/journal, or click “Journal” in the menu bar above. PulmCCM Journal’s mission is to [… read more]
Cardiopulmonary Resuscitation by Jon-Emile S. Kenny, MD The first time I performed cardiopulmonary resuscitation [CPR] on a patient was in the emergency department of Sunnybrook Hospital in Toronto, Canada; it was certainly an indelible moment in my training. As an intern, and especially as medical consult at Bellevue Hospital in New York City, I was [… read more]
Hot off the blog-press is PulmCCM’s new Educational Resources section. This exciting new endeavor will be a forum for sharing your knowledge with the world. If you’ve created a useful educational clinical resource, why limit your audience to your colleagues at your local institution? Increase your impact exponentially by posting your work on PulmCCM where thousands can learn and benefit. [… read more]
Image: Airwaycam Endotracheal intubation is a routine but high-stakes maneuver, performed uneventfully thousands of times daily throughout the developed world. In the U.S., elective (routine) intubation is almost exclusively the domain of anesthesiologists, who become masters of the technique through thousands of iterations throughout training and their careers. The vast majority of these intubations take [… read more]
Subglottic suctioning can prevent ventilator-associated pneumonia (VAP), but much of the research showing its benefits was performed prior to wide adoption of the so-called “VAP bundle,” widely believed to reduce VAP incidence. This led some to question any additive benefits of subglottic suctioning. Authors of a new randomized trial found that subglottic suctioning also reduced ventilator-associated pneumonia incidence in a [… read more]
Image: Wikipedia Acute pancreatitis is a common and usually self-limited illness resolving after a few days of rest and not eating. A minority of people develop severe pancreatitis with necrosis, which can transform pancreatitis into an ordeal lasting weeks or months, characterized by multi-organ failure, infections, and a >15% mortality rate. Those infections are believed to be caused by [… read more]
The smoking cessation drug varenicline (Chantix) works by weakly activating and also blocking nicotine receptors in the brain, simultaneously. This neat trick has the dual effects of reducing tobacco cravings while also blunting the “high” from smoking. That combination has made Chantix the most successful smoking-cessation therapy on the market, but it costs about $500 for [… read more]
Here are some of the biggest stories and most important published research findings in critical care and respiratory medicine for 2014. Enjoy, and subscribe to the PulmCCM weekly email newsletter to stay up to date in pulmonary and critical care. Early goal directed therapy does not improve outcomes in septic shock (ProCESS) Are traditional protocols [… read more]
In the early 1990s, the clot-busting drug alteplase (intravenous recombinant tissue plasminogen activator or rTPA) revolutionized stroke treatment when it was shown to significantly increase the chances of a good outcome after ischemic stroke when given in the first 4.5 hours since symptom onset. But alteplase is not a miracle drug. In a meta-analysis of 9 randomized trials, rTPA improved [… read more]
Put a CT scanner in every U.S. emergency department, add the non-specific signs and symptoms of pulmonary embolism, stir in its potential lethality and morbidity, and line up a few thousand lawyers on the sidelines ready to capitalize on any missed diagnoses, and it’s no wonder that the use of CT-angiograms to rule out pulmonary embolism has risen 11-fold [… read more]
Ignoring its advisory panel, the Centers for Medicare and Medicaid Services (CMS) announced that annual low-dose CT lung cancer screening for high-risk individuals will be covered by Medicare. However, CMS applied restrictions that will limit access to screening, avoiding the chaotic marketplace free-for-all that would have resulted from an unrestricted approval. Medicare will pay for one lung cancer [… read more]
In Defense of the Central Venous Pressure Jon-Emile S. Kenny M.D. In the waning days of my fellowship I received a hemoptysis consult in the cardiac care unit. Sifting through CT scans, I overheard two house-officers giving sign-out for the evening. When reviewing the clinical data, one of the residents referred to the central venous pressure [… read more]
2014 has been a rough year for advocates of sepsis protocols. First, the long-awaited ProCESS trial did not show any benefit from use of the original early goal-directed therapy (EGDT) protocol used in the single-center 2001 trial by Rivers et al that, despite criticism, became the standard of care for the following decade. Patients cared for in the 2 non-EGDT arms [… read more]
Olodaterol People with severe chronic obstructive pulmonary disease (COPD) often have persistent dyspnea or exacerbations despite the use of a single controller inhaler. (Controller inhalers for COPD most often include combination inhaled corticosteroid/long-acting beta agonists like Advair, Dulera and Symbicort [ICS/LABAs] and the long-acting anticholinergic agent Spiriva/tiotropium). These patients often take both a combination ICS/LABA and Spiriva, so-called [… read more]
The U.S. FDA approved the first two drugs proven to slow progression of idiopathic pulmonary fibrosis (IPF): pirfenidone (Esbriet by Roche, which bought Intermune) and nintedanib (Ofev by Boehringer Ingelheim) on Wednesday October 15. Both drugs will offer new hope for patients, and new pain to the insurance companies and the government who pay for them. Pirfenidone [… read more]
Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [… read more]
Feeding patients enterally (nasogastric or nasojejunal tube feedings) has been the standard of care for critically ill patients, based on weak evidence that it reduces infection rates; hence the adage “feed the gut, if you can.” That last caveat is included because so many critically ill patients have gastric motility impairment (with inability to achieve [… read more]
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