Pulmonary/Critical Care Relias Media - Continuing Medical Education Publishing https://www.reliasmedia.com/ The most award winning healthcare information source, trusted for four decades by physicians and nurses for CME / CE covering medical topics from emergency medicine to case management en-US Thu, 28 Mar 2024 02:22:34 -0700 Thu, 28 Mar 2024 02:22:34 -0700 false Withholding Intubation in Select Comatose Patients with Acute Poisoning May Be Beneficial Critical Care Alert https://www.reliasmedia.com/articles/withholding-intubation-in-select-comatose-patients-with-acute-poisoning-may-be-beneficial Tue, 12 Mar 2024 11:31:00 -0700 https://www.reliasmedia.com/articles/withholding-intubation-in-select-comatose-patients-with-acute-poisoning-may-be-beneficial In this unblinded, randomized trial of adults presenting with acute poisoning and a Glasgow Coma Scale score less than 9, those for whom intubation was withheld unless emergently indicated had decreased intensive care unit and hospital lengths of stay and a lower rate of pneumonia.

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Low-Dose vs. Conventional-Dose TMP-SMX to Treat Pneumocystis Pneumonia in Non-HIV Patients Critical Care Alert https://www.reliasmedia.com/articles/low-dose-vs-conventional-dose-tmp-smx-to-treat-pneumocystis-pneumonia-in-non-hiv-patients Tue, 12 Mar 2024 11:22:00 -0700 https://www.reliasmedia.com/articles/low-dose-vs-conventional-dose-tmp-smx-to-treat-pneumocystis-pneumonia-in-non-hiv-patients In patients without human immunodeficiency virus who were diagnosed with Pneumocystis jirovecii pneumonia, mortality rates were similar between the low-dose vs. conventional-dose trimethoprim-sulfamethoxazole (TMP-SMX) groups, while low-dose TMP-SMX was associated with fewer adverse events.

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High-Flow Nasal Oxygen for Acute Hypoxemic Respiratory Failure Due to COVID-19 Is Safe Initiated Outside the ICU Critical Care Alert https://www.reliasmedia.com/articles/high-flow-nasal-oxygen-for-acute-hypoxemic-respiratory-failure-due-to-covid-19-is-safe-initiated-outside-the-icu Tue, 12 Mar 2024 11:15:00 -0700 https://www.reliasmedia.com/articles/high-flow-nasal-oxygen-for-acute-hypoxemic-respiratory-failure-due-to-covid-19-is-safe-initiated-outside-the-icu This study of hospitalized adults with COVID-19-related hypoxemic respiratory failure found that initiation of high-flow nasal oxygen on the wards was safe, resulted in comparable intubation and mortality rates, and led to less time in the intensive care unit.

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Norepinephrine Can Be Infused Safely Via Peripheral IV Catheter Critical Care Alert https://www.reliasmedia.com/articles/norepinephrine-can-be-infused-safely-via-peripheral-iv-catheter Tue, 12 Mar 2024 10:49:00 -0700 https://www.reliasmedia.com/articles/norepinephrine-can-be-infused-safely-via-peripheral-iv-catheter Peripheral administration of norepinephrine has a low risk of extravasation if following an operationalized protocol.

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ICU Delirium Linked to Post-Discharge Change in Cancer Treatment and Higher Mortality Among Cancer Patients Critical Care Alert https://www.reliasmedia.com/articles/icu-delirium-linked-to-post-discharge-change-in-cancer-treatment-and-higher-mortality-among-cancer-patients Mon, 12 Feb 2024 09:34:00 -0800 https://www.reliasmedia.com/articles/icu-delirium-linked-to-post-discharge-change-in-cancer-treatment-and-higher-mortality-among-cancer-patients In this single-center, retrospective cohort study, intensive care unit (ICU) delirium was associated with a higher rate of cancer treatment modification, only partly due to worsening performance status, after discharge and higher one-year mortality.

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Does Alkaline Phosphatase Reduce Sepsis-Associated Acute Kidney Injury? Critical Care Alert https://www.reliasmedia.com/articles/does-alkaline-phosphatase-reduce-sepsis-associated-acute-kidney-injury Mon, 12 Feb 2024 09:24:00 -0800 https://www.reliasmedia.com/articles/does-alkaline-phosphatase-reduce-sepsis-associated-acute-kidney-injury This Phase III, international, multicenter, double-blind, randomized controlled trial did not show a reduction in 28-day all-cause mortality with ilofotase alfa (recombinant human alkaline phosphatase). However, the study showed evidence to suggest that ilofotase alfa reduced major adverse kidney events at 90 days, mainly driven by lowering the incidence of renal replacement therapy through day 90 in these patients.

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Ventilation and Oxygenation Considerations During and After Cardiopulmonary Resuscitation Critical Care Alert https://www.reliasmedia.com/articles/ventilation-and-oxygenation-considerations-during-and-after-cardiopulmonary-resuscitation Mon, 12 Feb 2024 09:17:00 -0800 https://www.reliasmedia.com/articles/ventilation-and-oxygenation-considerations-during-and-after-cardiopulmonary-resuscitation With a multitude of recommendations spanning from monitoring during cardiopulmonary resuscitation (CPR) to post-arrest targeted temperature management, the specific focus of this article is to review considerations related to ventilation and oxygenation during and after CPR.

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Percutaneous Coronary Intervention vs. Placebo for Stable Angina Patients Critical Care Alert https://www.reliasmedia.com/articles/percutaneous-coronary-intervention-vs-placebo-for-stable-angina-patients-2 Sat, 13 Jan 2024 14:19:00 -0800 https://www.reliasmedia.com/articles/percutaneous-coronary-intervention-vs-placebo-for-stable-angina-patients-2 In this randomized trial of patients with stable angina and objective evidence of ischemia, percutaneous coronary intervention resulted in a significant reduction in angina compared to a placebo procedure.

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Small-Volume Blood Collection May Reduce Transfusion Needs in the ICU Critical Care Alert https://www.reliasmedia.com/articles/small-volume-blood-collection-may-reduce-transfusion-needs-in-the-icu Sat, 13 Jan 2024 14:05:00 -0800 https://www.reliasmedia.com/articles/small-volume-blood-collection-may-reduce-transfusion-needs-in-the-icu The STRATUS randomized clinical trial was a stepped-wedge cluster randomized trial in 25 adult medical-surgical intensive care units (ICUs) in Canada that studied standard-volume to small-volume vacuum tubes for blood collection in the ICU. In the primary analysis, there was no significant difference in red blood cell transfusion between groups. However, in a pre-specified secondary analysis, red blood cell transfusion decreased after the transition from standard-volume tubes to small-volume tubes.

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Buprenorphine May Be an Effective Alternative to Full Opioids for Pain  in the ICU Critical Care Alert https://www.reliasmedia.com/articles/buprenorphine-may-be-an-effective-alternative-to-full-opioids-for-pain-in-the-icu Sat, 13 Jan 2024 13:58:00 -0800 https://www.reliasmedia.com/articles/buprenorphine-may-be-an-effective-alternative-to-full-opioids-for-pain-in-the-icu In a small, single-center, retrospective, propensity-matched cohort study examining enteral oxycodone vs. sublingual buprenorphine in a critically ill population, pain control was equivalent, indicating that sublingual buprenorphine may be an effective and appropriate alternative.

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Using Targeted Trials to Investigate Early vs. Late Intubation Strategies Critical Care Alert https://www.reliasmedia.com/articles/using-targeted-trials-to-investigate-early-vs-late-intubation-strategies Sat, 13 Jan 2024 13:52:00 -0800 https://www.reliasmedia.com/articles/using-targeted-trials-to-investigate-early-vs-late-intubation-strategies Authors used a machine learning framework to show that delaying intubation in critically ill patients when compared to early intubation does not result in a greater 30-day mortality.

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Bougie or Stylet Upfront for Endotracheal Intubation Critical Care Alert https://www.reliasmedia.com/articles/bougie-or-stylet-upfront-for-endotracheal-intubation Fri, 08 Dec 2023 08:34:00 -0800 https://www.reliasmedia.com/articles/bougie-or-stylet-upfront-for-endotracheal-intubation In this secondary analysis of the BOUGIE trial, patient and operator characteristics may affect successful intubation with either technique despite no difference in outcomes in the primary analysis.

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Time of Day Affects the Probability of Antibiotic Initiation for Hospitalized Patients with Sepsis Critical Care Alert https://www.reliasmedia.com/articles/time-of-day-affects-the-probability-of-antibiotic-initiation-for-hospitalized-patients-with-sepsis Mon, 13 Nov 2023 07:42:00 -0800 https://www.reliasmedia.com/articles/time-of-day-affects-the-probability-of-antibiotic-initiation-for-hospitalized-patients-with-sepsis In this retrospective cohort study of patients with hospital-onset sepsis, the probability of antibiotic initiation was lowest at shift changes and gradually declined overnight compared to during the day shift.

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Extracorporeal Life Support Does Not Improve Outcomes in Patients with Cardiogenic Shock Receiving Early Revascularization Critical Care Alert https://www.reliasmedia.com/articles/extracorporeal-life-support-does-not-improve-outcomes-in-patients-with-cardiogenic-shock-receiving-early-revascularization Mon, 13 Nov 2023 07:31:00 -0800 https://www.reliasmedia.com/articles/extracorporeal-life-support-does-not-improve-outcomes-in-patients-with-cardiogenic-shock-receiving-early-revascularization The use of extracorporeal cardiopulmonary resuscitation (ECPR) in patients with acute myocardial infarction-related cardiogenic shock who underwent early revascularization did not result in improved mortality at 30 days and resulted in more major bleeding and peripheral vascular complications.

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Strike the Balance: Evolving Venous Access Practices in the Intensive Care Unit Critical Care Alert https://www.reliasmedia.com/articles/strike-the-balance-evolving-venous-access-practices-in-the-intensive-care-unit Mon, 13 Nov 2023 07:20:00 -0800 https://www.reliasmedia.com/articles/strike-the-balance-evolving-venous-access-practices-in-the-intensive-care-unit This feature offers a focused review of the existing literature on PICC and temporary CVC use in the critically ill for healthcare professionals navigating this rapidly evolving field during their daily clinical activities.

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Lung Ultrasound Score Can Adequately Diagnose Acute Respiratory Distress Syndrome Critical Care Alert https://www.reliasmedia.com/articles/lung-ultrasound-score-can-adequately-diagnose-acute-respiratory-distress-syndrome Sat, 14 Oct 2023 16:57:00 -0700 https://www.reliasmedia.com/articles/lung-ultrasound-score-can-adequately-diagnose-acute-respiratory-distress-syndrome In this prospective, observational study, lung ultrasound showed comparable diagnostic performance to standard diagnostics but better accuracy.

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Diagnosis and Management of Pulmonary Embolism in the ICU Critical Care Alert https://www.reliasmedia.com/articles/diagnosis-and-management-of-pulmonary-embolism-in-the-icu Fri, 13 Oct 2023 13:07:00 -0700 https://www.reliasmedia.com/articles/diagnosis-and-management-of-pulmonary-embolism-in-the-icu Prompt diagnosis and management of pulmonary embolism in the emergency room and intensive care unit (ICU), therefore, may affect the course of these patients.

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Clinicians Consider Many Factors When Deciding on Mechanical Ventilation After Sepsis Critical Care Alert https://www.reliasmedia.com/articles/clinicians-consider-many-factors-when-deciding-on-mechanical-ventilation-after-sepsis Thu, 28 Sep 2023 02:00:00 -0700 https://www.reliasmedia.com/articles/clinicians-consider-many-factors-when-deciding-on-mechanical-ventilation-after-sepsis Identifying patients at high risk and crafting timely, targeted interventions can improve outcomes.

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Incident Dementia Cases Connected to Long-Term Air Pollution Exposure Neurology Alert https://www.reliasmedia.com/articles/incident-dementia-cases-connected-to-long-term-air-pollution-exposure Tue, 15 Aug 2023 02:00:00 -0700 https://www.reliasmedia.com/articles/incident-dementia-cases-connected-to-long-term-air-pollution-exposure Researchers reported fine particulate matter from agriculture and open fires to be especially harmful.

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Adjuvant Systemic Corticosteroid Therapy in Hospitalized Patients with Community-Acquired Pneumonia Internal Medicine Alert https://www.reliasmedia.com/articles/adjuvant-systemic-corticosteroid-therapy-in-hospitalized-patients-with-community-acquired-pneumonia-2 Wed, 14 Jun 2023 02:00:00 -0700 https://www.reliasmedia.com/articles/adjuvant-systemic-corticosteroid-therapy-in-hospitalized-patients-with-community-acquired-pneumonia-2 In this meta-analysis, all-cause mortality, ICU admission, and incidence of adverse events were similar in patients who received corticosteroids compared to standard care. However, the corticosteroid therapy group recorded a lower incidence of progression to mechanical ventilation.

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Practice Alert Provides Critical Care Nurses Safety Tips for Prone Positioning Critical Care Alert https://www.reliasmedia.com/articles/practice-alert-provides-critical-care-nurses-safety-tips-for-prone-positioning Thu, 01 Jun 2023 02:00:00 -0700 https://www.reliasmedia.com/articles/practice-alert-provides-critical-care-nurses-safety-tips-for-prone-positioning The technique that became well known during the COVID-19 pandemic remains a standard tactic for managing acute respiratory distress syndrome.

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Does Surviving an ECMO Stay Put Patients at Greater Risk for Mental Health Problems? Internal Medicine Alert https://www.reliasmedia.com/articles/does-surviving-an-ecmo-stay-put-patients-at-greater-risk-for-mental-health-problems-2 Thu, 23 Feb 2023 02:00:00 -0800 https://www.reliasmedia.com/articles/does-surviving-an-ecmo-stay-put-patients-at-greater-risk-for-mental-health-problems-2 Survivors of extracorporeal membrane oxygenation (ECMO) demonstrated a modest increase in risk of new mental health diagnoses after discharge vs. ICU survivors who do not undergo ECMO.

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ECMO-Supported CPR Disappoints for Treating Out-of-Hospital Cardiac Arrest Clinical Cardiology Alert https://www.reliasmedia.com/articles/ecmo-supported-cpr-disappoints-for-treating-out-of-hospital-cardiac-arrest Wed, 15 Feb 2023 02:00:00 -0800 https://www.reliasmedia.com/articles/ecmo-supported-cpr-disappoints-for-treating-out-of-hospital-cardiac-arrest For patients with out-of-hospital cardiac arrest that was refractory to initial resuscitation efforts, adding extracorporeal membrane oxygenation to standard CPR did not result in a significant improvement in survival with favorable neurologic outcome.

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Long-Term Air Pollution Exposure Could Raise Risk for Depression, Anxiety Internal Medicine Alert https://www.reliasmedia.com/articles/long-term-air-pollution-exposure-could-raise-risk-for-depression-anxiety Tue, 14 Feb 2023 02:00:00 -0800 https://www.reliasmedia.com/articles/long-term-air-pollution-exposure-could-raise-risk-for-depression-anxiety Two research groups reported on breathing dirty air and how that affects mental health.

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Persistent Asthma Patients Show More Plaque Buildup, Inflammation Clinical Cardiology Alert https://www.reliasmedia.com/articles/persistent-asthma-patients-show-more-plaque-buildup-inflammation Mon, 28 Nov 2022 02:00:00 -0800 https://www.reliasmedia.com/articles/persistent-asthma-patients-show-more-plaque-buildup-inflammation Pulmonary ailment could speed carotid artery damage, create more inflammatory biomarkers.

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Scientists Are Worried About Air Quality and Dementia Risk Neurology Alert https://www.reliasmedia.com/articles/scientists-are-worried-about-air-quality-and-dementia-risk Fri, 28 Oct 2022 02:00:00 -0700 https://www.reliasmedia.com/articles/scientists-are-worried-about-air-quality-and-dementia-risk Traffic-related air pollution raises red flags for neurological health.

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‘Informed Assent’ for CPR Is Reasonable Approach for Some Hospitalized Patients Medical Ethics Advisor https://www.reliasmedia.com/articles/informed-assent-for-cpr-is-reasonable-approach-for-some-hospitalized-patients Thu, 20 Oct 2022 02:00:00 -0700 https://www.reliasmedia.com/articles/informed-assent-for-cpr-is-reasonable-approach-for-some-hospitalized-patients This concept was developed to satisfy the right of physicians to initiate DNR orders in futile situations and their duty to communicate to patients and lawful surrogates. Through informed assent, physicians state they will write a DNR order because it would be futile and harmful to the patient to attempt CPR in their current serious illness.

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Appropriate Oxygenation Targets in the Treatment of Hypoxemic Respiratory Failure Critical Care Alert https://www.reliasmedia.com/articles/appropriate-oxygenation-targets-in-the-treatment-of-hypoxemic-respiratory-failure Thu, 15 Sep 2022 02:00:00 -0700 https://www.reliasmedia.com/articles/appropriate-oxygenation-targets-in-the-treatment-of-hypoxemic-respiratory-failure The care of critically ill patients in the ICU remains challenging. Recent studies support current protocols for the delivery of oxygen to patients who require supplemental oxygen due to respiratory failure of varying etiologies. Broad oxygenation targets of SpO2 between 88% to 97% continue to be supported by recent trials.

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Limitation of Tidal Volume Is Cardioprotective Among Mechanically Ventilated Patients Undergoing Cardiac Surgery Critical Care Alert https://www.reliasmedia.com/articles/limitation-of-tidal-volume-is-cardioprotective-among-mechanically-ventilated-patients-undergoing-cardiac-surgery Thu, 15 Sep 2022 02:00:00 -0700 https://www.reliasmedia.com/articles/limitation-of-tidal-volume-is-cardioprotective-among-mechanically-ventilated-patients-undergoing-cardiac-surgery In this experimental study, rising tidal volume increased right ventricular afterload.

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Healthcare Industry Embraces Firearm Safety Law - No Issue https://www.reliasmedia.com/articles/149634-healthcare-industry-embraces-firearm-safety-law Tue, 28 Jun 2022 10:49:14 -0700 https://www.reliasmedia.com/articles/149634-healthcare-industry-embraces-firearm-safety-law Various groups thank Congress, White House for swift action on bipartisan legislation.

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FDA Approves Generic Treatment for COPD, Asthma - No Issue https://www.reliasmedia.com/articles/149262-fda-approves-generic-treatment-for-copd-asthma Fri, 18 Mar 2022 08:21:59 -0700 https://www.reliasmedia.com/articles/149262-fda-approves-generic-treatment-for-copd-asthma Agency aims to stimulate competition, expand access to cheaper meds.

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Air Filters and Asthma - Internal Medicine Alert – July 15, 2021 Internal Medicine Alert https://www.reliasmedia.com/articles/148254-air-filters-and-asthma Tue, 22 Jun 2021 06:05:48 -0700 https://www.reliasmedia.com/articles/148254-air-filters-and-asthma Children with asthma showed improved small airway mechanics following indoor filtration of particulates (2.5 µm and greater) using high-efficiency particulate air filtration devices.]]> Lung Health Program Revamped to Help Manage COVID-19 Pandemic - Hospital Peer Review – May 1, 2021 Hospital Peer Review https://www.reliasmedia.com/articles/147875-lung-health-program-revamped-to-help-manage-covid-19-pandemic Thu, 01 Apr 2021 09:49:09 -0700 https://www.reliasmedia.com/articles/147875-lung-health-program-revamped-to-help-manage-covid-19-pandemic A Maryland hospital adapted an existing program encouraging lung health to respond to the sudden demands of COVID-19. The program helped reduce COVID-19 readmission rates by two-thirds.

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Chronic Obstructive Pulmonary Disease: Update - No Issue Primary Care Reports https://www.reliasmedia.com/articles/136559-chronic-obstructive-pulmonary-disease-update Tue, 20 Oct 2015 13:00:04 -0700 https://www.reliasmedia.com/articles/136559-chronic-obstructive-pulmonary-disease-update Over the past decade, this definition of COPD has changed dramatically, as has the characterization and treatment of individuals with COPD. Multiple new therapies alter the course of this disease, reduce exacerbations, improve quality of life, and increase survival; previous nihilistic approaches to the management of COPD have been replaced by directed and effective pharmacologic and nonpharmacologic therapies. This update will review current approaches to the diagnosis and management of COPD and present the most recent evidence for the classification of COPD phenotypes and the implications of these categories for COPD treatment and prognosis.

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