Category Archives: Pulmonary and Critical Care

Machines better for CPR

This meta-analysis of 12 studies of out-of-hospital cardiac arrest found that machine-delivered CPR was associated with ~1.5 times the odds of return of spontaneous circulation compared to human CPR. This may also be true for in-hospital arrest but needs further … Continue reading

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Following the pulmonary nodule

New updated guidelines provide guidance for what to do when a solitary pulmonary nodule is discovered on imaging. Among the recommendations: Obtain prior imaging; stability over 2 years does not require any further follow up. If no prior imaging for … Continue reading

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Statins for sepsis

This randomized trial of 250 patients with sepsis, who were randomized to 14 days of statin or placebo, found no difference in serum markers of inflammation, organ dysfunction scores or morality between the groups. However, they did find that among … Continue reading

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Pneumococcal pneumonia still bad news

This cohort from the VA found those confirmed with pneumococcal pneumonia had a 12% 1 month mortality, and a 10 year mortality rate of~30%, which is higher than age-matched expectations. The prognosis was worse with bacteremic disease, and with higher … Continue reading

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Survival after discharge after in-hospital cardiac arrest

This large cohort of patients age>65 who survived in-hospital cardiac arrest found that 1 year after discharge, 59% were still alive, and 34% had not been readmitted to the hospital. Both mortality and readmission rates were substantially affected by the … Continue reading

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Family presence during CPR

In this trial of out-of-hospital cardiac arrest, families were randomized to be offered to watch CPR, or not offered. CPR was witnessed by 79% of the intervention families, versus 43% of the control families. The frequency of PTSD symptoms, anxiety, … Continue reading

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Effect of delirium in critically ill

This meta-analysis of critically ill patients found significantly worse outcomes in those that experience delirium compared to those that do not, including higher mortality, more complications, longer vent duration, and longer ICU and hospital LOS (abstract). Continued efforts for prevention … Continue reading

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Mild therapeutic hypothermia after cardiac arrest

This meta-analysis found that mild therapeutic hypothermia after cardiac arrest is both safe and effective and should be standard practice (abstract).

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Updated guidelines from surviving sepsis campaign

The Surviving Sepsis Campaign guidelines have been updated. Some of the highlights include (abstract): Initial fluids with crystalloids at 30cc/kg, with goal in first 6 hours of CVP 8-12mmHg, MAP>65 mmHg, and urine output >0.5cc/kg/hr; Antibiotics within 1 hour No … Continue reading

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Noninvasive ventilation for acute COPD

In this large retrospective analysis of patients hospitalized with acute COPD exacerbations with respiratory failure, the use of noninvasive ventilation increased from 14% to 16% from 2006 to 2008, but variation in use between hospitals was great (ranging from 0 … Continue reading

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