Mechanical Ventilation in ARDS: Overview Mechanical ventilation in ARDS is almost always required, as people with acute respiratory distress syndrome are by definition severely hypoxemic. Yet mechanical ventilation itself can further injure damaged lungs(so-called ventilator induced lung injury); minimizing any additional damage while maintaining adequate gas exchange (“compatible with life”) is the central goal of mechanical [… read more]
Reimbursement for Palliative Care in the ICU By Intensivists To an intensivist, providing palliative care often means having multiple time-consuming and emotionally challenging interactions with families struggling to cope with the impending loss of their loved one. The emotional content of these interactions can be strongly positive, negative, or somewhere in between, but frequently it’s [… read more]
Chronic Obstructive Pulmonary Disease (COPD) Review Epidemiology of COPD Globally, ~10% of people older than 40 have airflow limitation of GOLD stage 2 or worse (FEV1 < 80% predicted); up to 25% may have GOLD stage 1 (FEV1 ≥ 80% predicted but FEV1/FVC < 0.7). Up to 60-85% of people with COPD (mostly mild/moderate severity) [… read more]
The content here previously has been removed at the request of the American College of Chest Physicians. For the ACCP’s Guidelines for Diagnosis and Management of DVT/PE/VTE, 9th edition, please visit the ACCP’s web site. PulmCCM is not affiliated with the ACCP.
The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.
Mechanisms of Pneumothorax in the Critically Ill Air can accumulate in the pleural space in three ways: Rupture of the visceral pleura allowing air to travel from alveoli to the pleural space (an “internal” pneumothorax, as from barotrauma from mechanical ventilation, or the rupture of a bulla or bleb); Entry of air from the atmosphere [… read more]
We have our hands full at PulmCCM Central just keeping up with the best published literature in pulmonary and critical care medicine. Somehow, the folks at NYU manage to vet the much larger volume of literature published in internal medicine, and offer it in a user-friendly review in their Clinical Correlations blog. Clinical Correlations is [… read more]
The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.
Westermark sign: a focal area of decreased lucency on a plain chest film with an abrupt cut-off in the pulmonary artery, corresponding to a central occlusive pulmonary embolism. A.S. Krishnan and Tristan Barrett share a nice example of the Westermark sign in the March 15 New England Journal.
Diaphragmatic dysfunction can result from nerve damage, primary muscle problems, or problems with the muscle’s interaction with the chest wall. The true incidence of diaphragmatic paralysis is unknown, since many patients are asymptomatic. Treatment for diaphragmatic dysfunction usually consists of watchful waiting, addressing underlying causes, with mechanical ventilation if respiratory failure develops. Causes of Diaphragmatic [… read more]
The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.
The content previously here was removed at the request of the American College of Chest Physicians. For the ACCP 9th edition clinical practice guidelines for prevention and treatment of venous thromboembolism (VTE), please visit the ACCP website. PulmCCM is not affiliated with ACCP or Chest.
Daily interruption of sedation (daily awakening or sedation holidays) works like a charm to get patients off the ventilator, faster. After proving that a decade or so ago, practice-changers John Kress and William Schweickert have turned their attention to early mobilization as the next intervention that could help mechanically ventilated patients escape the ventilator faster. [… read more]
The content here previously has been removed at the request of the American College of Chest Physicians. For the ACCP’s Guidelines for Diagnosis and Management of DVT/PE/VTE, 9th edition, please visit the ACCP’s web site. PulmCCM is not affiliated with the ACCP.
Januel et al report findings of a systematic review and meta-analysis to estimate the total incidence of acute symptomatic venous thromboembolism (symptomatic DVT or pulmonary embolism) among patients receiving proper thromboprophylaxis after hip or knee replacements. They came up with rates of 1.1% after knee replacements, and 0.5% after hip replacements. The rate of pulmonary [… read more]
The benefits of corticosteroids as a treatment for severe sepsis and septic shock (if any) are unknown: Although adrenal suppression is common in sepsis, it is still unclear how to assess adrenal function, or whether it should be done at all. The sensitivity and specificity of the cosyntropin (ACTH) stimulation test are unknown, and its [… read more]
C. difficile has always been a foul and disgusting adversary, but lately it’s becoming more formidable and deadly, according to Linda Bobo, Erik Dubberke and Marin Kollef. A few highlights of this excellent review: C.diff infections (CDI) have more than doubled since 2001, to > 340,000 discharges in 2008. Attributable mortality is 6-7%, but may [… read more]
As you know, the risk for DVT and PE in the ICU are high. How high? Depends on how you count them. Asymptomatic, ultrasound-surveillance-detected DVTs have an incidence of 5-10% during the ICU stay (from the PROTECT trial and a 2005 series), even when patients receive proper thromboprophylaxis. The incidence is even higher (up to 80%) in trauma [… read more]
[poll id=”3″] A 2005 meta-analysis of 5 studies (n=406) concluded that early tracheostomy reduced need for mechanical ventilation and ICU days. But then a 2006 randomized trial in trauma patients found no benefit to early trach, and an underpowered 2008 RCT also found no benefit. In a new meta-analysis and systematic review of 7 trials (n=1,044), Fei [… read more]
Many argue that as a limited resource serving unlimited needs, medical care is “rationed” by definition, and ICU resources (being more limited and expensive) are simply more overtly rationed. For example, in France, ICU admission is often denied to the very elderly critically ill, explicitly because of their age (this happens in the U.K., too, probably). In the U.S., [… read more]
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