Total parenteral nutrition vs enteral nutrition: no difference in critically ill? (CALORIES trial)

Feeding patients enterally (nasogastric or nasojejunal tube feedings) has been the standard of care for critically ill patients, based on weak evidence that it reduces infection rates; hence the adage “feed the gut, if you can.” That last caveat is included because so many critically ill patients have gastric motility impairment (with inability to achieve [... read more]

The post Total parenteral nutrition vs enteral nutrition: no difference in critically ill? (CALORIES trial) appeared first on PulmCCM.

Transfusion for hemoglobin above 7 g/dL: no benefit in septic shock (TRISS Trial)

Blood transfusions have been a central component of protocols for care of severe sepsis and septic shock, ever since the single-center 2001 Rivers trial included them in its interventions. Any benefit (or harm) caused by red cell transfusion independently was unknowable, and the therapy remained a core element of the so-called sepsis bundle. The Surviving Sepsis [... read more]

The post Transfusion for hemoglobin above 7 g/dL: no benefit in septic shock (TRISS Trial) appeared first on PulmCCM.

Protocols for goal directed therapy for sepsis are pronounced dead (ARISE trial)

Protocols for goal directed therapy for sepsis and septic shock had their day in the sun. With the publication of the ARISE trial, they sleep with the fishes. You remember that in May 2014, the large U.S. multicenter ProCESS trial showed that protocolized sepsis care did not improve outcomes in patients as compared to individualized physician judgment. The even larger ARISE [... read more]

The post Protocols for goal directed therapy for sepsis are pronounced dead (ARISE trial) appeared first on PulmCCM.

PulmCCM Journal Publishes First Issue

I am proud to announce the publication of the first issue of PulmCCM Journal, a new online peer-reviewed journal in respiratory and critical care medicine. Please click through to read edition 1, volume 1, issue 1 online now:   Starting a journal as an extension of a blog designed to cope with an overabundance of journals may [... read more]

The post PulmCCM Journal Publishes First Issue appeared first on PulmCCM.

All the best in PulmCCM (Roundup #6)

All the best in the pulmonary and critical care medicine literature from our ongoing journal survey. Browse all the PulmCCM Roundups to stay up to date. Thrombolytics for Pulmonary Embolism: New Metaanalysis Most patients with massive pulmonary embolism (PE with shock) should receive thrombolytics, but it’s unclear from randomized trial data which patients with submassive pulmonary embolism [... read more]

The post All the best in PulmCCM (Roundup #6) appeared first on PulmCCM.

New 2014 Pulmonary Hypertension guidelines released

The American College of Chest Physicians (unaffiliated with PulmCCM) published its new consensus guidelines in August 2014 for the drug treatment of pulmonary arterial hypertension (PAH). They’re free to view on the Chest website, and well worth a look. Remember that pulmonary arterial hypertension (PAH) is but one small subset (“Group 1″) of the much larger [... read more]

The post New 2014 Pulmonary Hypertension guidelines released appeared first on PulmCCM.