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February 2013 pulmonary journal club
Mathew M
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Effect of pressure support vs unassisted breathing through a tracheostomy collar on weaning duration in patients requiring prolonged mechanical ventilation: a randomized trial. Jubran A, Grant BJ, Duffner LA, Collins EG, Lanuza DM, Hoffman LA, Tobin MJ. JAMA. 2013;309(7):671-7. The rise in prolonged mechanical ventilation has fostered a growth in the need for long term acute care hospitals (LTACH). The February Journal Club reviewed the study looking at ventilator weaning through pressure support trials vs. spontaneous breathing through tracheostomy collar in a LTACH. The study was a randomized trial performed from 2000 - 2010. It was performed at a single long term acute care facility. Patients that required mechanical ventilation for > 21 days and failed a 5 day screening procedure of spontaneous breathing were included in the study. Included patients were randomized to either a pressure support or tracheostomy collar arm. 500 patients were screened, and a total of …
March 2013 critical care journal club
Stander P
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Brill S. Bitter Pill: Why Medical Bills Are Killing Us. Time. February 20, 2013. PDF available at: http://livingwithmcl.com/BitterPill.pdf (accessed 4/2/13). Editor’s Note: We had a special journal club in March. First, we reviewed an article from Time magazine rather than a traditional medical journal. Second, Paul Stander MD, the chief medical officer at Banner Good Samaritan Regional Medical Center, led the discussion and agreed to author the journal club. This seemed appropriate since much of the article focuses on overbilling and administrative costs of care. The recent lengthy cover story article in Time Magazine described in great deal what many of us practicing physicians have realized for a long time – our health care system is highly dysfunctional and much of that dysfunction is a result of an arcane and outmoded financing mechanism. This payment system has a litany of perverse incentives that encourage wasteful and often ineffective care while not …
April 2013 critical care journal club  [cached]
Raschke RA
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. We welcomed intensivists from Banner Health to video-conference with us as we discussed several articles, and evaluated the ACP Journal Club – another good resource for keeping up to date.Hill NS. Review: Lower rather than higher tidal volume benefits ventilated patients without ARDS. Ann Intern Med. 2013;158:JC4. AbstractLauzier F. Hydroxyethyl starch 130/0.4 and saline did not differ for mortality at 90 days in ICU patients. Ann Intern Med. 2013;158:JC5. AbstractThe April ACP Journal Club reviewed two critical care articles – a meta-analysis that concluded that low tidal volume ventilation reduced mortality in patients without ARDS, and a large RCT that showed no mortality difference between critically-ill patients resuscitated with hydroxyethyl starch versus saline. Both articles were awarded 6/7 stars for “clinical impact”, yet neither article had any impact on our clinical practice. This troubled us.We could think of 4 necessary criteria in order for research to have legitimate …
January 2013 critical care journal club  [cached]
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Villanueva C, Colomo A, Bosch A, Concepción M, Hernandez-Gea V, Aracil C, Graupera I, Poca M, Alvarez-Urturi C, Gordillo J, Guarner-Argente C, Santaló M, Mu iz E, Guarner C. Transfusion strategies for acute upper gastrointestinal bleeding. N Engl J Med. 2013;368(1):11-21. The hemoglobin threshold for transfusion of red cells in patients with acute gastrointestinal bleeding is controversial. The authors compared the efficacy and safety of a restrictive transfusion strategy (transfusion when the hemoglobin level fell below 7 g per deciliter) with a liberal transfusion strategy in 921 patients with severe acute upper gastrointestinal bleeding. The probability of survival at 6 weeks was higher in the restrictive-strategy group than in the liberal-strategy group and the probability of further bleeding adverse events were lower. This article may alter practices in the ICU. Previously, many intensivists, including myself, thought it was important to make sure that we “stayed ahead” of the bleeding. This study …
March 2013 pulmonary journal club  [cached]
Mathew M
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Reignier J, Mercier E, Le Gouge A, Boulain T, Desachy A, Bellec F, Clavel M, Frat JP, Plantefeve G, Quenot JP, Lascarrou JB; Clinical Research in Intensive Care and Sepsis (CRICS) Group. Effect of not monitoring residual gastric volume on risk of ventilator-associated pneumonia in adults receiving mechanical ventilation and early enteral feeding: a randomized controlled trial. JAMA. 2013;309(3):249-56. The March pulmonary journal club reviewed the article looking at the effect of gastric residual volume and ventilator associated pneumonia. Most of us would agree that enteral nutrition in the critically ill patient is important but how early and how much is still debatable. In many institutions gastric residual volumes are used to assess gastric motility and help guide rate and cessation of enteral nutrition. This study evaluated the effect of not monitoring gastric residual volume and its effect on ventilator associated pneumonia. The study was a randomized multicenter non- inferiority …
January 2013 pulmonary journal club
Robbins RA
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Kartalija M, Ovrutsky AR, Bryan CL, Pott GB, Fantuzzi G, Thomas J, Strand MJ, Bai X, Ramamoorthy P, Rothman MS, Nagabhushanam V, McDermott M, Levin AR, Frazer-Abel A, Giclas PC, Korner J, Iseman MD, Shapiro L, Chan ED. Patients with nontuberculous mycobacterial lung disease exhibit unique body and immune phenotypes. Am J Respir Crit Care Med. 2013;187(2):197-205. Among patients with nontuberculous mycobacterial (NTM) lung disease is a subset of previously healthy women with a slender body morphotype, often with scoliosis and/or pectus excavatum. The authors enrolled 103 patients with NTM and 101 uninfected control subjects of similar demographics. Patients withNTM had significantly lower body mass index and body fat and were significantly taller than control subjects. Scoliosis, pectus excavatum and gastroesophageal reflux were significantly more prevalent in patients with NTM. The normal relationships between the adipokines and body fat were lost and IFN-g and IL-10 levels were significantly suppressed …
January 2013 sleep journal club
Roehrs JD
Southwest Journal of Pulmonary and Critical Care , 2013,
Abstract: No abstract available. Article truncated at 150 words. Jilwan FN, Escourrou P, Garcia G, Ja s X, Humbert M, Roisman G. High occurrence of hypoxemic sleep respiratory disorders in precapillary pulmonary hypertension and mechanisms. CHEST. 2013;143(1):47-55. This is important study that highlights the interaction of pulmonary hypertension (PH) and hypoxemia with complications of sleep disordered breathing. The study intent was to delineate the mechanism of the hypoxemia. There is a well- known association between hypoxemia at night and pulmonary hypertension but the prevalence in studies has been variable. Sleep disordered breathing is also associated with PH but is generally thought to contribute little to the pathogenesis of the PH. Methods: 47 patients were entered into the study with 2/3 of patients having idiopathic PH and 1/3 chronic thromboembolic PH. All the chronic thromboembolic PH patients had undergone thromboendarterctomy or had lesions that were inoperable. Most of the patients were in NYHA class 2 or 3 and were stable on …
October 2012 critical care journal club  [cached]
Robbins RA,Bajo TM
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: No abstract available. Article truncated at 150 words. Dr. Raschke was out of town when Critical Care Journal Club was held this month. Dr. Tom Bajo, the senior critical care physician at Good Samaritan, moderated the journal club. We reviewed 5 articles and 1 editorial. Thiele H, Zeymer U, Neumann FJ. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012 ;367:1287-96. This is an important article for those who manage myocardial infarction with cardiogenic shock. The ACA/AHA guidelines recommend intraaortic balloon counterpulsation as a class I treatment for cardiogenic shock complicating acute myocardial infarction. However, the evidence is based mainly on registry data, and there is a paucity of randomized clinical trials. In this randomized, prospective, open-label, multicenter trial, 600 patients with cardiogenic shock complicating acute myocardial infarction were randomized to intraaortic balloon counterpulsation or no intraaortic balloon counterpulsation. All patients were expected to undergo early revascularization (by means of percutaneous coronary intervention …
August 2012 critical care journal club  [cached]
Seth H,Uppalapu S,Poulos EM,Whiting T
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: No abstract available. Article truncated at 150 words. Dr. Raschke took a well-deserved vacation, and in his absence we did another quick-fire critical care journal club reviewing 7 articles.Davies AR, Morrison SS, Bailey MJ, Bellomo R, Cooper DJ, Doig GS, Finfer SR, Heyland DK; for the ENTERIC Study Investigators and the ANZICS Clinical Trials Group. A multicenter, randomized controlled trial comparing early nasojejunal with nasogastric nutrition in critical illness. Crit Care Med 2012;40:2342-8. (Click here for abstract)This was a randomized control trial, which enrolled 181 patients from multiple medical-surgical ICUs to receive either nasojejunal or nasogastric nutrition. The number of patients selected for this study provided an 80% power to detect a 12% difference in mean energy delivery. Inclusion criteria for the study were patient that were admitted to the ICU, needing mechanically ventilated, narcotic drips for sedation as well as elevated gastric residuals (>150ml). Patients were excluded if patient had abnormal anatomy or imminent death…
September 2012 critical care journal club  [cached]
Raschke RA
Southwest Journal of Pulmonary and Critical Care , 2012,
Abstract: No abstract available. Article truncated at 150 words. We had a great group of attending discussants at this Journal Club – thanks to all who participated including Drs. Jay Blum, Al Thomas, Clement Singarajah, Rick Robbins, Tom Bajo, Huw Owen Reece, and Roxanne Garcia Orr. Winters B, Custer J, Galvagno SM Jr, et al. Diagnostic errors in the intensive care unit: a systematic review of autopsy studies. BMJ Qual Saf 2012 Jul 24. [Epub ahead of print]The authors reviewed 45 years of autopsy studies of ICU patients to determine the most common missed diagnoses. Thirty-one studies including 5863 autopsies were included. Eight percent revealed a missed diagnosis with an adverse impact survival that would likely have changed therapy. More than 80% of these were vascular events (such as pulmonary embolism or acute myocardial infarction) and infections. Strangely, the authors detail all diagnostic categories except infection – this seems to have been an oversight error on their part. The authors …
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