Jon-Emile S. Kenny MD [@heart_lung] “It is a narrow mind which cannot look at a subject from various points of view.” -George Eliot Background On background reading for the recent entry on ‘Asthmatic Mechanics,’ I happened across a delightful case report submitted as a letter to the editor of the New England Journal of Medicine in [… read more]
Best of 2019 on PulmCCM: Keep O2 saturations at 96% or below for hospitalized patients, says expert panel Major asthma guideline update: ICS-LABA as-needed replaces albuterol 2019 IDSA Guidelines for Community Acquired Pneumonia Prolonged hypothermia improved neurologic outcomes after non-shockable cardiac arrests Hospitals should not implement one-hour sepsis bundles, say SCCM and ACEP Vitamin C [… read more]
Jon-Emile S. Kenny MD [@heart_lung] Background This synopsis will address the basic geometric calculation of respiratory system work for a single breath [in joules] and power [i.e. joules/seconds or watts] which is work multiplied by the respiratory rate. This geometric approach will then be used to explain two shorthand equations – the second of which was [… read more]
New Guideline Emphasizes Treatment of Drug-Resistant Tuberculosis with All-Oral Regimens for MDR-TB Patients The American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society and the Infectious Diseases Society of America have published an official clinical guideline on the treatment of drug-resistant tuberculosis (DR-TB) in the Nov. 15 American Journal of Respiratory and [… read more]
by Zeena Nackerdien PhD, CME Writer, MedPage Today Recent estimates point to a rise in NTM lung disease in the U.S., particularly among those older than 50 or those with chronic underlying lung diseases, such as non-cystic fibrosis bronchiectasis, cystic fibrosis, and emphysema. According to a 1997-2007 estimate of the Medicare population (≥65 years old), NTM lung [… read more]
Jon-Emile S. Kenny MD [@heart_lung] “Dying is a wild night and a new road.” -Emily Dickinson Background In 2006, a recruitment maneuver to achieve an ‘open lung’ was circulated; it has since been dubbed ‘stairway recruitment’ given its stepwise upthrusts in airway pressure [see figure 1]: Plodding up this ladder of airway pressure was meant to [… read more]
Jon-Emile S. Kenny MD [@heart_lung] Recently, Josh Farkas and Scott Weingart gave a series of engrossing posts and podcasts on asthma. I especially liked their deliberations on mechanical ventilation which inspired me – no pun intended – to create a vodcast of my own and, like a novice troubleshooting a ventilator alarm, poke and prod at [… read more]
By Salynn Boyles, Contributing Writer, MedPage Today Tweaking a widely accepted strategy for assessing pulmonary embolism risk ruled out thrombosis and reduced chest imaging by a third among low-risk patients enrolled in a prospective study. Assessment of clinical pretest probability (C-PTP, calculated by the Wells score) and blood D-dimer level are used to assess pulmonary embolism [… read more]
More than 32 million people in the U.S. have reported penicillin allergies — about 10% of the population. But almost 95% of them are not penicillin-allergic, and are removing themselves from eligibility for ideal antibiotic treatments, according to a review in JAMA. “More than 1 in 10 people who seek medical care self-report a history [… read more]
Inhaled corticosteroids have been the mainstay of treatment for persistent asthma for decades. A new trial suggests that for the ~50% of asthma patients with low sputum eosinophils, inhaled steroids are no better than placebo, and neither was tiotropium. Treatment with the inhaled glucocorticoid mometasone or the long-acting muscarinic antagonist tiotropium resulted in similar outcomes [… read more]
Medicare announced it will now pay for a new molecular tissue test for idiopathic pulmonary fibrosis, called the Envisia Genomic Classifier (Veracyte). The availability of the new assay reshuffles the algorithm for the diagnosis of IPF, forcing consideration of transbronchial biopsy in some patients. However, professional societies do not yet endorse its general use. The [… read more]
Electromagnetic navigation bronchoscopy (ENB) can allow biopsy of peripheral pulmonary nodules that are usually not accessible with conventional bronchoscopy. Navigational bronchoscopy requires specialized training and equipment costing hundreds of thousands of dollars, and is not widely available outside urban centers. Multiple studies have reported varying yields and complication rates with ENB, but most have been [… read more]
Undergraduate biomedical engineering students have developed the first prototype of a laryngoscope blade whose future iterations could allow novices or robots to intubate patients as well as expert humans. The new laryngoscope blade has embedded force sensors that calculate its location in the airway. The sensors were trained using machine learning, with tactile patterns generated [… read more]
Jon-Emile S. Kenny MD [@heart_lung] Commonly, we are sold that acute pulmonary thromboembolism [PE] burns the right ventricular [RV] candle at both ends. This is because perfusion of the right coronary artery [RCA] is mediated by both its upstream mean arterial pressure [MAP] and downstream right ventricular end-diastolic pressure [RVEDP]. Given that a PE may decrease [… read more]
Jon-Emile S. Kenny MD [@heart_lung] What if I told you that in acute pulmonary thromboembolism [PE] that the initiation of intravenous norepinephrine [NE] decreases the calculated pulmonary vascular resistance [cPVR]? Would you believe me? Certainly, you would trust that an infusion of a thrombolytic does so. Of great interest, both NE and thrombolytics decrease the cPVR [… read more]
The CDC has concluded that vitamin E acetate in vaping oils containing THC (tetrahydrocannabinol) is responsible for many cases of vaping-related lung injury. There have been over 2,051 confirmed and probable cases of e-cigarette or vaping-associated lung injury (EVALI), with 39 deaths. CDC made its advisement based on the consistent presence of vitamin E acetate [… read more]
Beta-blockers have generally been considered safe and beneficial for patients with COPD, but a new randomized trial calls that assumption into doubt. The use of oral beta blockers without a cardiac indication appeared to double the risk of hospitalization for people experiencing a COPD exacerbation. Authors randomized 532 patients with moderate or severe COPD with [… read more]
Jon-Emile S. Kenny MD [@heart_lung] The transient and reversible loss of consciousness that may accompany pulmonary embolism [PE] is well-documented [1-7]. This brief post will not address the controversy regarding the prevalence of PE in ‘unexplained’ syncope; rather, it will focus on pathomechanisms and serve as the foundation for a few forthcoming entries on pulmonary thromboembolism [… read more]
Tens of millions of adults in the U.S. have obstructive sleep apnea (OSA), but most are mild cases that pose low health risks. A greater danger is faced by the smaller number of people with sleep apnea that progresses to obesity hypoventilation syndrome (OHS), a life-threatening condition. Obesity hypoventilation syndrome — an impairment in resting [… read more]
Use of C-reactive protein (CRP) in decision-making may reduce antibiotic use in COPD exacerbations, but not as a replacement for clinical judgment, a study suggested. Chronic obstructive pulmonary disease (COPD) exacerbations are characterized by increased inflammation in the airways and the body generally. C-reactive protein (CRP) is a serum test for inflammation, and has been [… read more]
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