Randomized Controlled Trials

Dec 292012
 
An aspirin a day keeps recurrent DVT and PE away (RCT)

(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]

Dec 262012
 
Pleural catheters equal to pleurodesis for dyspnea relief from malignant effusions (TIME2)

(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]

Dec 242012
 
Hydroxyethyl starches kill people with severe sepsis; use crystalloid instead (RCT)

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]

Dec 232012
 
Nicotine patches don't help in pregnancy, esp. if you don't wear them (RCT)

(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]

Dec 222012
 
Trophic feeding equal to full enteric feeding in acute lung injury (EDEN trial)

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]

Dec 222012
 
Lansoprazole didn't help kids with uncontrolled asthma (RCT)

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]

Dec 202012
 
CPAP cures metabolic syndrome in obstructive sleep apnea (Retracted)

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]

Dec 182012
 
Enoxaparin prophylaxis: no effect on mortality or fatal pulmonary embolism (RCT)

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]

Dec 042012
 
Linezolid (Zyvox) good for MDR, XDR tuberculosis (RCT)

Linezolid (Zyvox) for XDR-TB: New Hope, New Caution Approved by the FDA in 2000 for drug-resistant gram positive bacterial infections, linezolid (Zyvox, Pfizer) has in clinical practice been mainly used for skin infections and the occasional pneumonia due to methicillin-resistant Staph aureus (MRSA). Now linezolid looks to be effective as an adjunct therapy for multi-drug resistant [… read more]

Nov 292012
 
Normal saline: toxic to kidneys? Chloride solutions may cause renal failure

Does Normal Saline Cause Acute Renal Failure? To internal medicine-trained physicians in the U.S., normal saline solution seems as harmless and healthy as mother’s milk. Intensivists trained in anesthesia or surgery might more often mention normal saline’s hypertonicity compared to blood, and its propensity to cause hyperchloremia, compared to lactated Ringer’s or similar solutions. But [… read more]

Nov 232012
 
Intensive glucose control in kids: no brain injury vs. standard care 3 yrs later (RCT)

Intensive Glucose Control: Safe for Critically Ill Kids’ Brains? After evangelizing globally for intensive glucose control (~100 mg/dL) to be the standard of care for virtually all critically ill adults for a decade, Greet van den Berghe might be disappointed that mounting evidence shows that a fanatical approach to maintenance of normoglycemia in critical illness [… read more]

Nov 062012
 
Lung volume reduction coils improve dyspnea, FEV1 in COPD (RCT)

(image: PneumRx) ATLANTA — In a small, open-label pilot study, bronchoscopically-placed metal coils that retract emphysematous lung, creating lung volume reduction without surgery, produced functional and airflow improvements in a majority of patients with severe COPD, the lead researcher reported at CHEST 2012. Investigators randomized 47 patients with severe emphysema type COPD to undergo either [… read more]

Oct 262012
 
Vitamin D is for "doesn't do diddly" for the common cold (RCT)

Extra Vitamin D Doesn’t Prevent Colds in Healthy Adults (JAMA) It looks like you can add Vitamin D to list of supplements (echinacea, vitamin C, etc.) who’ve gone up against the common cold and lost. (Scorekeepers will note that zinc held its own, though, in a Cochrane analysis.) Vitamin D plays an important role in immune responses, [… read more]

Oct 192012
 
"Practice ischemia" on an arm reduces contrast nephropathy after procedures (RCT)

Contrast-induced nephropathy (kidney damage) is a serious problem that can occur after many medical tests and procedures, but coronary angiography (cardiac catheterization) is the main culprit. People with pre-existing renal disease are most susceptible to contrast-induced nephropathy (CIN) — about 1 in 8 of them develop a “bump” in creatinine of >0.5 mg/dL after cardiac [… read more]

Oct 042012
 
Post-pyloric feeding no better than usual NG tube in vented patients (RCT)

Image: EIMJM.com Evidence-based practice guidelines adopted by critical care societies in Canada, Germany, Australia and New Zealand recommend starting enteral nutrition for critical illness shortly after admission to an ICU. In observational studies, critically ill adults get only about 50-70% their caloric goals from enteral feeding; reduced gastric motility is often responsible for the limited [… read more]

Sep 202012
 
Gabapentin improved chronic cough in randomized trial

Chronic cough is the scourge both of the coughers themselves, and the doctors who treat them. Although rarely medically serious, chronic cough can be surprisingly debilitating by disrupting sufferers’ social and professional lives. Doctors, for their part, often feel frustrated and powerless in treating chronic cough. Although gastroesophageal reflux disease (GERD), asthma, ACE inhibitor use, [… read more]

Jul 092012
 
Meropenem + moxifloxacin: no improvement over meropenem alone in severe sepsis (RCT)

In the first randomized trial of its kind, patients with severe sepsis or septic shock who were given meropenem alone had equivalent clinical outcomes to patients who were given combination therapy including meropenem and moxifloxacin. The results, reported in JAMA, provide ethical support to critical care physicians who prefer to be conservative antibiotic stewards. But [… read more]

Jul 072012
 
GM-CSF (Leukine) for acute lung injury & ARDS (RCT)

Human recombinant granulocyte macrophage colony stimulating factor (GM-CSF or Leukine) did not reduce ventilator-days in patients with acute lung injury / ARDS in a randomized trial published in the January 2012 Critical Care Medicine. Why would it have? Interestingly, patients with ARDS with higher levels of GM-CSF in their BAL fluid are more likely to survive. GM-CSF maintains [… 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]