(image: Rxhealthdrugs.com) Azithromycin for Prevention of COPD Exacerbations Azithromycin taken daily prevents exacerbations of chronic obstructive pulmonary disease (COPD exacerbations), but seems to also carry risks for cardiovascular death and hearing loss. The true balance of risks and benefits with use of azithromycin to prevent COPD exacerbations is unknown, but physicians who choose to prescribe [… read more]
Azithromycin for non-CF Bronchiectasis Bronchiectasis — the permanently dilated, tortuous bronchi that can result after previous lung infections — is a frustrating problem for pulmonologists to treat, but not nearly as frustrating as it can be for patients to live with. People with bronchiectasis are plagued by chronic coughing, and many experience a steady decline [… read more]
“We’ve got to get that femoral line out of there!” The attending’s face as he says it shadowed with a simmer of fear, a dash of anger. How could the moonlighter have been so incompetent or lazy as to choose the benighted femoral site for a central venous line when the internal jugular and subclavian [… read more]
Daily Inhaled Steroids Stunt Kids’ Growth, Study Shows If you’re a half-inch shy of six feet, the next time you’re getting your jump shot blocked by your non-asthmatic friend, you can blame the inhaled corticosteroids your Mom made you take as a kid. Studies have consistently showed children’s height slows down for a few years [… read more]
Consensus guidelines advise that patients with regular symptoms of asthma should take inhaled corticosteroids every day, and when they’re having poor asthma control, they should tell their doctor, who can increase the steroid dose or add other “step-up” therapies. But asthma symptoms vary daily and can worsen at any time. And it can be hard [… read more]
Spiriva (Tiotropium) for Uncontrolled Asthma Most people with asthma can achieve good control with inhaled corticosteroids (ICS) and a long-acting beta-agonist (LABA). Some people living with asthma, though, experience persistent symptoms despite maximum doses of these inhaled medications. Fairly or not, LABAs have also been sullied with an FDA black-box warning for worsening bronchospasm in a [… read more]
The use of positron emission tomography — better known as PET scans — has grown dramatically over the past 15 years, thanks to their seemingly magical ability to identify foci of undetected metastatic cancer. But PET scans’ perceived high accuracy in diagnosing metastatic non-small cell lung cancer (NSCLC) — a published 94% sensitivity and 83% [… read more]
It started with a friendly pro/con debate in the December 2011 Chest, about whether lactate clearance or mixed venous oxygen saturation is a better “goal” for early goal-directed therapy in severe sepsis and septic shock. It ended with Alan Jones reviving rumors and innuendo that have swirled around Emanuel Rivers’s 2001 sepsis trial, and by extension his entire body [… read more]
Hydroxyethyl Starch (Voluven) Causes Kidney Failure In Large Trial Hydroxyethyl starch (HES) was already wearing a scarlet letter as an potentially dangerous volume resuscitation agent for patients in shock, after evidence emerged this year that hydroxyethyl starch kills people with severe sepsis. Now, another huge, convincing trial shows that hydroxyethyl starch (Voluven) damages kidneys and [… read more]
In most areas of life, it helps to be tall, and needing treatment for ARDS further proves the rule. Tall people are less likely to get harmful lung-distending tidal volumes during mechanical ventilation, simply by virtue of having bigger lungs. It’s bad enough that we intensivists might discriminate against the under-six-feet crowd (of which I [… read more]
(image: Wikipedia) With increasing use of chest CT, incidental mediastinal lymphadenopathy seems to be frequently discovered and subsequently biopsied using EBUS. The “if it’s enlarged, stick a needle in it” mantra is challenged by a paper by Stigt et al. 83 people (age ~59) with at least one incidentally discovered mediastinal lymph node > 1 [… read more]
(image: Wikipedia) An expert panel announced a new definition and severity classfication system for acute respiratory distress syndrome (ARDS) that aims to simplify the diagnosis and better prognosticate outcomes from the life-threatening pulmonary illness. The proposed “Berlin definition of ARDS” predicted mortality ever-so-slightly better than the existing ARDS criteria (created at the 1994 American-European Consensus [… read more]
(image: Rxhealthdrugs.com) People taking 5 days of azithromycin had a very small absolute increased risk of death, especially due to cardiovascular causes, compared to people taking amoxicillin, in a retrospective cohort review by Wayne Ray, Katherine Murray, and C. Michael Stein published in the May 17 New England Journal of Medicine. Erythromycin and clarithromycin (the other [… read more]
Recombinant human activated protein C or dotrecogin alfa — better known as Xigris, by Eli Lilly — seemed a godsend when it was first approved for treatment of severe sepsis in 2001. Xigris’ FDA approval (despite an evenly split 10-10 vote) was based solely on the Eli Lilly-funded PROWESS study, a phase 3 randomized trial [… read more]
Xarelto (rivaroxaban): New FDA Indication for DVT, PE The U.S. Food and Drug Administration (FDA) approved Bayer’s Xarelto (rivaroxaban) for a new indication for treating deep vein thrombosis (DVT) or pulmonary embolism (PE), and for long-term prophylaxis of recurrent DVT and PE. Xarelto already had FDA approval for prevention of DVTs and PEs after knee or [… read more]
(image: InPharm) Rivaroxaban (Xarelto) was noninferior to standard treatment (heparin and warfarin) in preventing recurrent VTE in patients with acute pulmonary embolism (PE), in the large EINSTEIN-PE randomized trial published in the April 5 New England Journal of Medicine. A once-daily oral factor Xa inhibitor that has already been demonstrated to be noninferior for treatment [… read more]
(image: Rex Parker) Among people with unprovoked deep venous thrombosis (DVT) or pulmonary embolism (PE), 1 in 5 will experience another DVT or PE within 2 years after stopping anticoagulation with warfarin (Coumadin). For this reason, the ACCP’s recommendations for treatment of unprovoked proximal DVT or PE suggest consideration of an “indefinite” period of anticoagulation [… read more]
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]
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