The American College of Chest Physicians (ACCP) has issued its long-awaited recommendations on lung cancer screening with chest CT — and far from a ringing endorsement of screening, they are conservative and subdued, emphasizing the potential risks of an uncontrolled approach to lung cancer screening in the general population. The American Society of Clinical Oncology [… read more]
The American Lung Association has become the largest advisory body to recommend lung cancer screening for high-risk people, advising nearly all people aged 55-74 with a 30+ pack-year smoking history (the entry criteria for the National Lung Screening Trial, or NLST) to undergo low-dose CT scanning to detect early lung cancer. The National Comprehensive Cancer Network, [… read more]
More: Surviving Sepsis Guidelines Review / Update The Surviving Sepsis Campaign is a collaboration between the U.S. Society of Critical Care Medicine (SCCM), the European Society of Intensive Care Medicine, and the International Sepsis Forum, whose recommendations on the management of sepsis are considered widely. At the 2012 SCCM meeting, the Surviving Sepsis committee revealed [… read more]
(image: Wikipedia) Access the online GAP Score Calculator for IPF Although idiopathic pulmonary fibrosis (IPF) has a poor prognosis — a median survival of only 3 years — there is wide heterogeneity among individual patients. Some have a precipitous decline and die within months of diagnosis; others live for a decade or longer, with little [… read more]
(image: Wikipedia) In the TIME2 randomized trial published in the June 13 2012 JAMA, indwelling pleural catheters and talc pleurodesis were equivalent at reducing dyspnea over the 6 weeks following the procedure among 106 patients with malignant pleural effusions. Most patients receiving pleural catheters required no hospital stays, and overall had fewer repeat procedures than those [… read more]
We intensivists are a scarce and valuable commodity — just ask us, we’ll tell you. It’s been consistently shown, for example, that involved intensivists in an ICU during the day correlates with improved mortality and efficiencies in care. Now that’s something we can all cheer (ourselves) about. Many intensivists also like to sleep, and may [… read more]
Colloids are believed to be more effective expanders of plasma volume than crystalloids, making them a tempting therapy to use for patients in septic shock and other causes of hemodynamic instability. Problem is, some colloid solutions seem to kill people. The VISEP Trial using hydroxyethyl starch 200 kDa/0.5 demonstrated that this high molecular weight HES [… read more]
There’s no use in sugar-coating the truth: Nicotine is an appetite suppressant, and smoking prevents weight gain. Not wanting to gain weight is a common reason why body-obsessed teenage girls say they smoke–and as far as we know, they’re “right:” teens who smoke gain slightly less weight than teens who don’t. It’s also long been believed [… read more]
The American Association of Blood Blanks (AABB) announced upcoming new guidelines in the March online Annals of Internal Medicine, recommending against transfusion for adults and children with stable illness and hemoglobin levels above 7-8 g/dL. They made it a 1A recommendation (strong recommendation with high quality evidence). Jeffrey Carson et al reviewed literature from 1950 to 2011 and [… read more]
(image: Smokersworld.info) You never see pregnant women smoking in public, but surveys say 12-25% of pregnant women in developed countries smoke during pregnancy. Of course they know they shouldn’t — with smoking’s increased risks for miscarriage, low birth weight, premature birth, birth defects, and even sudden infant death after delivery. Most pregnant women want badly [… read more]
Where should we set the dial for caloric delivery to our patients with acute lung injury and acute respiratory distress syndrome (ARDS)? Weak observational trials suggest low caloric intake might be associated with poor outcomes [ref1, 2]. On the other hand, other observational data suggests just the opposite: restricting calories early on may reduce ventilator [… read more]
Proton Pump Inhibitors No Help for Kids’ Asthma Gastroesophageal reflux (GER) is a mysterious co-conspirator with asthma. Many people with uncontrolled asthma have reflux (either symptomatic by history, or asymptomatic and detected on esophageal pH studies). Randomized trials in adults suggest that treating symptomatic GERD (gastroesophageal reflux DISEASE) improves asthma, but treating asymptomatic GER does not [… read more]
Smoking marijuana moderately over years is strongly associated with small improvements in lung function, even compared to people who have never smoked cigarettes or marijuana, according to a study in JAMA. But the popular news media and the study authors downplayed that finding of the study, apparently to avoid sending a pro-marijuana message. Mark Pletcher, [… read more]
New Trachea Grown, Transplanted In Two Men Paolo Macchiarini, Philipp Jungebluth et al report in Lancet their successful bioprosthetic trachea creation and transplantation in a 36-year old man in Sweden after a distal tracheal resection for recurrent primary tracheal cancer. The same group transplanted a bioengineered trachea into a 30-year old Baltimore man, who is [… read more]
CPAP Improves Metabolic Syndrome in Obstructive Sleep Apnea This paper has been RETRACTED! Continuous positive airway pressure (CPAP) therapy reversed elements of the high cardiovascular risk profile known as metabolic syndrome in a substantial minority of Indians with treatment-naive obstructive sleep apnea, according to this article in the New England Journal of Medicine. More than [… read more]
Kalydeco: New Drug Helps Some with Cystic Fibrosis On January 31, the FDA approved ivacaftor (Kalydeco), the first-ever drug that treats an underlying cause of cystic fibrosis. In about 4% of cystic fibrosis patients, defective chloride ion channel transporters (CFTRs) are trafficked to the cell membrane, but don’t work properly. Kalydeco “unlocks” and improves function [… read more]
Does Enoxaparin Prophylaxis Really Help Most Hospitalized Patients? A huge randomized trial (LIFENOX) stunned experts by showing no benefit of enoxaparin prophylaxis in preventing pulmonary embolism or all-cause mortality in acutely ill medical patients, compared to knee-length graduated compression stockings alone. Ajay Kakkar, Claudio Cimminiello, Jean-Francois Bergmann et al report their surprising results in the [… read more]
Adding Spiriva to LABA and Inhaled Steroid Might Improve COPD No strong outcomes-based evidence exists as to the benefits in treating chronic obstructive pulmonary disease (COPD) with tiotropium, long-acting beta-agonist and inhaled corticosteroid together — so called “triple therapy.” LABA and tiotropium together do provide additive bronchodilation over either agent alone, evidence suggests. However, only [… read more]
Just How “Dangerous” Are Long-Acting Beta-Agonists, Really? Gustavo Rodriguez and Jose Castro-Rodriguez reviewed 20 systematic reviews and databases reporting on the incidence of adverse events with long-acting beta-agonist (LABA) therapy for asthma, for the April 2012 Thorax. They conclude the following: LABAs as monotherapy significantly increase the risk for adverse effects and bad outcomes from [… read more]
DECAF Score Predicts COPD Exacerbation Mortality, But Needs Validation By Brett Ley, MD Despite improvements in care, death during hospitalization for acute exacerbation of COPD (AECOPD) is not uncommon. In the UK in 2008, almost 1 in 12 people admitted with a COPD exacerbation died in-hospital. In the U.S. in 1996, about 1 in 40 [… read more]
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