Review Articles

Jul 102012
 
Sharpen your eye with these free online radiology tutorials

Pulmonologists become fairly good semi-professional chest radiologists simply by showing up, paying attention and working hard during their training, and making an effort to keep learning throughout their careers. We have the advantage over radiologists of actually being able to “clinically correlate” the findings with what’s really going on, and to integrate that into our understanding [… read more]

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 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 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]