Jun 302012
 
Ventilator bundles (VAP bundles) not evidence-based, shouldn't be standard care

(image: Wikipedia) Anyone who has ever rounded in an ICU with a nurse manager knows that challenging or questioning the utility of the ventilator associated pneumonia (VAP) bundle is a losing proposition — one likely to get you labeled as a wiseguy troublemaker. Thanks to ventilator bundles’ endorsement by the nonprofit Institute for Healthcare Improvement, [… read more]

Jun 292012
 
Could excess ICU beds be hazardous to your health?

Everyone knows that when you’re really sick, going to the ICU–that place with all the beeping monitors, hypervigilant staff, and high-tech invasive gadgetry–might save your life. But what if in certain situations, transfer to an ICU bed could actually worsen a person’s condition, or even hasten their demise? Hannah Wunsch of Columbia U. suggests it’s [… read more]

Jun 272012
 
Pertussis underdiagnosed; adult booster-vaccine prevents "whoop" & infant deaths

This gentleman (not pictured in the photo) graciously allowed himself to be videotaped in the midst of a severe whooping cough episode caused by Bordetella pertussis; the video is posted on the New England Journal’s website. He had not been vaccinated: vaccination during childhood greatly reduces the risk of severe or life-threatening pertussis infection, and reduces [… read more]

Jun 232012
 
Acupuncture improved COPD in a "real" randomized trial

Acupuncture has danced on the fringes of mainstream Western medical therapy for decades. Acupuncture has been shown to improve numerous conditions –for example, reducing dyspnea in patients with cancer, asthma and chronic obstructive pulmonary disease (COPD) in a few randomized trials. But — unsurprisingly, given complementary medicine’s lack of funding and acceptance among traditional academics — [… read more]

Jun 222012
 
Palliative care exploding in U.S. hospitals (AP)

Hospitals added palliative care services at a feverish pace throughout the 2000s, the Associated Press reported in a piece picked up by news outlets across the U.S. in June. While 658 hospitals reported having palliative care programs in 2000, 1,568 reported they offered palliative care services in 2009 — that’s over 60% of the hospitals [… read more]

Jun 212012
 
Smoking is bad, quitting is good -- even for Great-Grandma

Most studies on smoking and its well-known health risks have been performed in middle-aged adults (younger than 60). In a large epidemiological study published in the June 11, 2012 Archives of Internal Medicine, Carolin Gellert, Ben Schottker, and Hermann Brenner showed that (spoiler alert!!) smoking’s excess risks extend to older adults, as well. Just as importantly, [… read more]

Jun 142012
 
Most clinical trials are too small, often underpowered

The past decade has seen an explosion in the number of clinical trials; there are now more than 10,000 new trials registered each year. Although clinical trials’ quality is improving somewhat, most are still small and single-center and a large proportion do not adhere with reporting requirements, raising serious questions as to what we are [… read more]

Jun 102012
 
Drowning (Review)

Drowning: 2012 Review (More PulmCCM Topic Updates) There are a thousand ways to die (it’s even a TV show), but few seem as horrible and inspire such primal fear as death by drowning. Drowning is uncommon but by no means rare in the U.S.: it’s the second leading cause of death by injury in the [… read more]

Jun 092012
 
COPD self-care program fail; unexplained deaths at VA hospitals (RCT)

Chronic diseases like chronic obstructive pulmonary disease (COPD) account for at least 2/3 of medical care spending in the U.S. Policy makers, payers, and many physicians recognize that the outpatient clinic-based model is poorly suited to provide support in between physician visits, when most complications or exacerbations occur. Many hospitalizations and decline in function could [… read more]

Jun 072012
 
Inhaled hypertonic saline for young kids with cystic fibrosis: no benefit? (RCT)

(image: Bennett Gamel blog) Inhaled hypertonic saline (7% NaCl) increases clearance of mucus by airway cilia, making it an attractive treatment for cystic fibrosis. Hypertonic saline has been a cornerstone of daily therapy for CF ever since a 2006 NEJM randomized trial showed that ~80 adults and kids older than 6 using hypertonic saline for [… read more]

Jun 012012
 
Bronchodilator reversibility testing in COPD: Bill for it, but don't believe it

(image: flickrCC) Why do we test chronic obstructive pulmonary disease (COPD) patients for bronchodilator responsiveness (besides getting to charging a few extra bucks for it)? If I am reading this article right, the answer is, there’s no good reason. Consider this: Bronchodilator responsiveness (BDR) or the lack thereof does not distinguish COPD from asthma. Bronchodilator [… read more]

May 252012
 
Fever reduction improves early mortality in septic shock? Take a closer look

by Scott Aberegg, MD, MPH It is rare occasion that one article allows me to review so many aspects of the epistemology of medical evidence, but alas Schortgen et al afforded me that opportunity in the May 15th issue of AJRCCM. The issues raised by this article are so numerous that I shall make subsections for each one. [… read more]

May 232012
 
For some LTAC patients, pessimism is the new kindness

(image: flickrCC) Half of patients transferred to long-term acute care facilities (LTACs) on prolonged mechanical ventilation will die within a year, according to a 2010 review. Only a small minority will ever go home without needing significant caregiver assistance. For those over age 65, the prognosis is even worse. It seems rude, or even cruel, [… read more]

May 172012
 
Where's the respect (and $$) for critical care research?

(image: Suburban Wino) Craig Coopersmith of Emory is an amazing guy and a prolific investigator in critical care — and it looks like he’s fed up with having his grants rejected. After some epic bean-counting, his group concludes that critical care research gets short shrift in federal research funding, compared to the huge amounts spent [… read more]