Review Articles

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 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 132012
 
Chantix: no excess cardiovascular risk in new meta-analysis

(image: People’s Pharmacy) Sure to re-light controversy around Pfizer’s varenicline (Chantix): a new study concludes the smoking cessation drug likely carries no increased risk for cardiovascular events.  Judith Prochaska and Joan Hilton (University of California – San Francisco) report the results in the May 4 BMJ. Sonal Singh (Johns Hopkins) et al’s previous meta-analysis, reported in CMAJ [… read more]

May 122012
 
Mechanical Ventilation in ARDS: Research Update

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]

May 102012
 
How to bill for palliative care in the ICU ... legally

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]

Apr 212012
 
Pneumothorax in the ICU

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]

Mar 152012
 

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]

Mar 022012
 
Walk to wean: Early mobilization for ventilated patients (Review, 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]

Feb 062012
 

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]

Feb 052012
 
Systemic steroids for severe sepsis and septic shock (Review)

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]