In a rare encouraging positive study in the chronically critically ill, 71% of vent-dependent patients (~6 weeks on MV) who did multiple sets of daily inspirations backwards through a PEEP valve weaned from mechanical ventilation (defined as >72 hrs off the vent), vs. 47% receiving a sham treatment. MIP also improved by 10 cmH2O in [… read more]
Pleural imaging; CHF pleural effusions; hepatic hydrothorax; parapneumonic effusions and empyema; malignant pleural effusions and disease; chylothorax; thoracoscopy; the chest tube size debate; pneumothorax — did they miss anything? In 130 pages, probably not much. Sem Resp Crit Care Med Dec 2010.
Cardiopulmonary exercise testing in people with heart and lung disease: Arena R, Circulation 2011;123:668-680.
Tashkin et al randomized 504 patients at 27 centers with COPD and FEV1 > 49% to varenicline or placebo for 12 weeks, with 52 weeks follow up. Smoking cessation / abstinence rate (carbon monoxide-confirmed) was 42% vs 9% in weeks 9 – 12 (1′ endpoint), and 19% vs. 6% in weeks 9 – 52 (p<0.0001). [… read more]
Point-of-care ultrasonography: Moore CL, NEJM 2011;364:749-757.
Clinical Course & Prediction of Survival in Idiopathic Pulmonary Fibrosis: Ley B, AJRCCM 2011;183:431-440.
Chai-Coetzer et al designed and validated a predictive model for diagnosing obstructive sleep apnea without polysomnography in 157 general primary care patients considered at average risk for obstructive sleep apnea. Berlin/Epworth questionnaires, snoring, waist size, witnessed apneas and age were fit into an algorithm, followed by home oximetry in a sample of mostly high-Berlin-scoring patients. [… read more]
Using Medicare records from more than 30,000 beneficiaries with congestive heart failure, Javaheri et al suggest in this observational epidemiologic study that sleep apnea may be woefully overlooked and undertreated in people with CHF. The 2% of the cohort who were tested and treated for sleep apnea had one-third the 2-year mortality of their risk-matched [… read more]
MedPAC wants the next generation of MDs to be cost-conscious, evidence-minded, and amenable to standardization of care. To prod GME programs to train young MDs thusly, the influential government advisory body recommends allocating $3.5B of the $9.5B annual GME outlay as at-risk incentive payments. A proposed committee would have 3 years to design metrics for [… read more]
DeMets & Califf give a historical play-by-play, lament the current state of affairs, and issue a call to arms for academics to leverage the current political climate favoring comparative-effectiveness and translational research, in order to build a new clinical trials edifice that favors the public’s health over profits. JAMA 2011;305:713-714.
Moses & Martin see an impending crisis of public trust in the entire enterprise. They call for an epic shift in national priorities, policy, and funding of research, envisioning a more collaborative, value-based system– while acknowledging that such a sea change would take decades. NEJM 2011;364:567-571. FREE FULL TEXT
Cao et al report experience with 186 patients with resected bronchopulmonary carcinoid in Australia; median survival was 20 years. Those older than 60 at presentation and/or with higher-grade/atypical tumor histopathology had worse survival. Ann Thorac Surg 2011;91:339-343.
The IASLC, ATS, and ERS got together to better incorporate clinical logic into classification of NSCLC. No more bronchioloalveolar carcinoma (they propose adenocarcinoma in situ or invasive mucinous adenocarcinoma, depending on its size). Large cell carcinoma with neuroendocrine features gets separated out of NSCLC entirely, so it can be treated as small cell. And so [… read more]
Song et al retrospectively reviewed 461 cases of IPF (269 biopsy-proven) in Korea. More than a third of patients were hospitalized for respiratory deteriorations over a 2-year period. About half the deteriorations were attributed to acute exacerbations of IPF, with most of the rest attributed to infections (half the patients had BAL and/or ET aspirates [… read more]
Aduen et al performed simultaneous echocardiograms and right heart catheterizations on 117 patients, concluding echo is more accurate and precise than others previously found. They also promote a method of calculating and reporting mean PA pressure on echo, rather than systolic PA pressure. Right heart catheterization remains indispensable as the gold standard. CHEST 2011;139:347-352
People (n=21) with inadequately controlled asthma in a supervised exercise program for 12 weeks followed by self-motivated exercise for 12 weeks had “clinically significant” 0.5-point lower scores on the Asthma Control Questionnaire, as well as improved aerobic fitness, compared to 16 nonrandomized matched controls. Astonishingly, no serious trial testing exercise in asthma control has ever [… read more]
The once-daily beta-agonist was better than placebo and at least as good as twice-daily salmeterol, as measured by the SGRQ, TDI, and FEV1 after 12 weeks. The drug previously matched up well against tiotropium. Indacaterol is available in Europe, but not in the U.S. (n=838). ERJ 2011;37:273-279.
McCormack et al randomized 89 women with lymphangioleiomyomatosis to receive 2 mg rapamycin or placebo daily for 12 months, followed by 12 months of drug-free observation. Women receiving sirolimus had stable lung function on spirometry, fewer symptoms, fewer “respiratory events,” and better quality of life during the treatment period. This was tempered by GI, dermatologic, [… read more]
Pulmonary Complications of Lung Transplantation: Ahmad, CHEST 2011;139:402-411.
Daily inhaled corticosteroids (ICS) may retard growth in children, who would rather play than take daily inhalers. Martinez et al randomized children with mild persistent asthma to four groups, one of which was beclomethasone + albuterol as rescue therapy only (i.e., no daily ICS), for 44 months. They did slightly worse than children taking daily [… read more]