Another Negative Study in Patients With Group 2 Pulmonary Hypertension Treated With Sildenafil, But Are We Looking at the Right Population?
Synopsis: In the multicenter, double-blind, randomized controlled SIOVAC trial, researchers found that patients with persistent pulmonary hypertension (PH) despite correction of valvular heart disease treated with sildenafil had worse composite clinical outcomes and increased admissions for heart failure exacerbations. This trial adds to the list of previous studies of group 2 PH in which phosphodiesterase-5 (PDE-5) inhibitors did not show clinical benefit. However, the population studied in this trial was not representative of the subpopulation of patients, with the hemodynamic phenotype of combined postcapillary and prec...
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Pulmonary Trends Source Type: research
Recurrent Pneumocytoma
We present a case of a young female patient who had successfully undergone sublobar resection of pneumocytoma 8 years previously and who presented with a histologically proven recurrence adjacent to the surgical staple line. Our case highlights the potential dangers of nonanatomic resection, including for benign entities. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
High-Flow Nasal Oxygen Therapy in Immunocompromised Patients With Acute Hypoxemic Respiratory Failure
Acute respiratory failure (ARF) is common in immunocompromised patients. Low/intermediate-flow oxygen devices have several drawbacks, such as insufficient humidification and warming of the inspired gas or limited FiO2, which imply suboptimal therapeutic management. Compared with unselected patients, immunocompromised patients are at higher risk of ARF, and ARF is associated with a 2-fold increase in intensive care unit or hospital mortality. As a consequence, decreasing the need for intubation by the improvement of oxygenation and ventilation techniques has become a major goal of care in this population. Besides noninvasiv...
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
Transfusion for Patients With Sepsis in 2018
Red blood cell transfusion (RBCT) threshold in patients with sepsis remains a matter of controversy. In this review, we report a summary of the benefits and risks of RBCT. We then focus on the latest studies addressing this controversy, including the randomized controlled trials dealing with the early goal-directed therapy, the randomized controlled trials comparing liberal versus restrictive transfusion strategies, and finally the cohort studies assessing the impact of RBCT. The conclusions of these studies no longer argue for a 10 g/dL (30% hematocrit) transfusion threshold during the early phase of septic shock. Simil...
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
The Lung Microbiome in Health and Respiratory Diseases
The human respiratory microbiota in health shows interpersonal differences related, among other factors, to unique anatomic and physiological characteristics, individual immune response, and environmental conditions. The stable but probably transient lung microbiota is originated by the continuous microaspirations of the oropharyngeal secretions that are later subjected to the clearance processes that take place in the lower respiratory tract. In exacerbations of chronic pulmonary diseases, a positive feedback cycle of inflammation and dysbiosis is produced that commonly ends in a reduction of the lung microbial diversity....
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Respiratory Infections/Topics in Pulmonary Medicine Source Type: research
Vocal Cord Dysfunction: A Review
Vocal cord dysfunction (VCD) is a functional disorder of the vocal folds, characterized by an abnormal adduction of the cords, resulting in respiratory symptoms, generally during inspiration. VCD poses diagnostic challenges for providers, as it can both mimic and coexist with asthma. The most common symptoms seen in VCD are dyspnea, throat tightness, dysphonia, and wheezing or stridor. Several mechanisms for VCD have been suggested, namely vocal cord inflammation due to irritating processes such as gastroesophageal reflux disease and after nasal drainage, although exercise and inhaled irritants are also known triggers. Com...
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Obstructive Airways Disease Source Type: research
A Technical Review of Commonly Used Tracheobronchial Stents by Interventional Pulmonologists
Over the past 20 years, there has been significant advancement in the discipline of interventional pulmonology with parallel growth of medical devices in this space. In particular, there is a numerous selection of tracheobronchial stents with unique insertion techniques available in the treatment of central airway obstruction. In severe or refractory tracheobronchial disease, airway stenting can be considered; however, complications including mucous impaction, granulation tissue formation, stent migration, and risk of infection must be acknowledged before the use of these devices. To date, there are many manufacturers of a...
Source: Clinical Pulmonary Medicine - July 1, 2018 Category: Respiratory Medicine Tags: Interventional Pulmonary Medicine Source Type: research
A New Alternative for Cancer-associated Venous Thromboembolism?
Synopsis: Low–molecular-weight heparin has been the drug of choice for cancer-associated venous thromboembolism, but oral Xa inhibitors may be equally effective.
Source: Raskob G, Verhamme P, Carrier M, et al. Edoxaban for the treatment of cancer-associated venous thromboembolism. N Engl J Med. 2017. (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Pulomonary Trends Source Type: research
Metformin as a Preventative Therapy for Tuberculosis in Diabetic Patients
Synopsis: In a retrospective cohort study of diabetic patients, metformin was compared with sulfonylureas, and it was found to have greater efficacy in preventing TB infection.
Source: Pan S, Yen Y, Kou Y, et al. The risk of tuberculosis disease in type 2 diabetes patients initiating metformin versus sulfonylureas. Chest 2017. DOI:http://dx.doi.org/10.1016/j.chest.2017.11.040 (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Pulomonary Trends Source Type: research
Multiple Pulmonary Nodules and Masses in an Asymptomatic Patient
The incidental detection of abnormalities at screening thoracic imaging examinations performed in asymptomatic patients, such as lung cancer screening with computed tomography or computed tomographic coronary artery calcium scoring for cardiac risk stratification, is a common event. Most such abnormalities, while often indeterminate, are nevertheless of no significance and can be approached conservatively. The detection of multiple nodules and masses in the screening setting is exceptional and usually mandates an aggressive approach toward establishing the diagnosis. Leading diagnostic considerations for such a presentatio...
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Images in Pulmonary Medicine Source Type: research
Role of Therapeutic and Interventional Bronchoscopy in the Intensive Care Unit
Bronchoscopy is a common tool utilized for both diagnostic and therapeutic purposes in a diversity of clinical scenarios. Flexible bronchoscopy is increasingly being used safely in the management of critically ill patients and facilitates the management of a variety of pulmonary disorders. This manuscript examines the utility of interventional bronchoscopy in the critical care setting.
Myth: Therapeutic bronchoscopy has a limited role in the management of patients in the intensive care unit (ICU). (Source: Clinical Pulmonary Medicine)
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Clinical Myths and Evidence-Based Medicine Source Type: research
Community-acquired Pneumonia and Acute Respiratory Distress Syndrome: Prevalence, Risk, and Prognosis
Severe community-acquired pneumonia is the most common cause of acute respiratory distress syndrome (ARDS). Despite multiple improvements in the last 10 years, this syndrome remains highly prevalent worldwide and is associated with high mortality and long-term morbidity rates. Several factors are related to the increasing risk of ARDS. Clinicians should be familiar with the use of lung-protective strategies and the mechanism of ventilator-induced lung injury, as ventilator management of ARDS is complex. Clinical trials are now needed, to investigate adjunctive therapies in patients with severe pneumonia and ARDS, such as s...
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Respiratory Infections Source Type: research
Sleep in Women Across the Stages of Life
From the age of menarche through menopause, women report insufficient sleep and insomnia more frequently than men of similar ages. The physiological and hormonal changes that occur during puberty, the menstrual cycle, pregnancy, perimenopause, and menopause all influence women’s sleep architecture and sleep quality. The prevalence of some sleep disorders, such as insomnia, hypersomnia, and restless legs syndrome are all higher in women compared with men. The prevalence of other sleep disorders, such as obstructive sleep apnea and some parasomnias, increase in women during specific stages of life. At the same time, there ...
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
CAL02 Liposomes and Other Antitoxins: A New Generation of Anti-Infectives
While new generations of existing classes of antibiotics have predominated pipelines, novel nonantibiotic approaches such as antitoxins are gradually taking a more prominent position to address today’s most challenging issues in the field, notably the threatening rise of resistant strains and the unacceptably high rates of treatment failure and mortality despite the best of care. This review presents the clinical stage broad-spectrum antitoxin agent CAL02, which is active against both gram-positive and gram-negative bacteria including ESKAPE pathogens. CAL02 neutralizes bacterial pore-forming toxins, enzymes, and toxin-e...
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Topics in Pulmonary Medicine Source Type: research
Readmissions Among Sepsis Survivors: Risk Factors and Prevention
Hospital readmissions are common and result in increased mortality and cost while reducing quality of life. Readmission rates have been subjected to increasing scrutiny in recent years as part of a larger effort to improve the quality and value of health care in the United States. Emerging evidence suggests that sepsis survivors are at high risk for hospital readmission and experience readmission rates comparable with survivors of congestive heart failure, acute myocardial infarction, pneumonia, and chronic obstructive pulmonary disease, diseases whose readmission rates determine reimbursement penalties from the federal go...
Source: Clinical Pulmonary Medicine - May 1, 2018 Category: Respiratory Medicine Tags: Critical Care/Respiratory Care Source Type: research
