Antibiotics for community-acquired pneumonia: Is azithromycin out?

Is it time for a change in the standard treatment of community-acquired pneumonia? A new Dutch study says, maybe. The Infectious Diseases Society of America (IDSA) says, not so fast. IDSA's guidelines for treatment of community acquired pneumonia were last updated in 2007. For patients admitted to the hospital but not needing the ICU, they have [... read more]

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Surviving Sepsis Says EGDT Not Needed in All Patients with Septic Shock

As regular PulmCCM readers know, the ProCESS, ARISE and ProMISe randomized trials showed no benefit of protocolized early goal-directed therapy as compared to usual conscientious care in the treatment of severe sepsis and septic shock. In response to ProCESS and ARISE, the influential Surviving Sepsis Campaign now advises that measurement of central venous pressure (CVP) and [... read more]

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Endovascular therapy helps in ischemic stroke, again (ESCAPE)

Endovascular Therapy Improves Outcomes from Ischemic Stroke By Parth Rali, MD and Igor Titoff, DO Endovascular therapy for ischemic stroke has long been an attractive treatment modality for ischemic strokes, but until recently large randomized trials have not confirmed a benefit [1,2,3]. Two of these—IMS III1 and SYNTHESIS2—failed to prove the benefit of endovascular therapy (with-or-without tissue plasminogen activator) [... read more]

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ProMISe Trial for Sepsis: Usual Care 3, Goal-Directed Therapy 0*

* (since 2014) The ARISE (Australasia) and ProCESS (U.S.) trials, published in 2014, each demonstrated no advantage of protocolized care for sepsis over conscientious usual care. For those remaining unconvinced, the U.K.-based ProMISe trial is available in the New England Journal of Medicine. ProMISe extends the growing global footprint of what some will call the [... read more]

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ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 2 of 2)

ICU Physiology in 1000 Words The Right Ventricular Afterload [Part 2 of 2] Jon-Emile S. Kenny M.D. [@heart_lung] Having considered the short-comings of Laplace’s Law and the PVR with respect to the RV afterload in part 1, we will now turn to each of the following in turn: the pulmonary arterial input impedance, a measureable [... read more]

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How safe is thoracentesis? Giant case series sheds light

Thoracentesis for pleural effusion — that is, inserting a long needle between someone's ribs to drain a fluid collection from the chest — has always come with a scary menu of potential risks, including pneumothorax, hemothorax and pulmonary edema. A new study reports a low complication rate from thousands of thoracenteses. But debate will remain whether the safety results -- achieved [... read more]

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