FDA approves pirfenidone (Esbriet) and nintedanib (Ofev) for IPF

The U.S. FDA approved the first two drugs proven to slow progression of idiopathic pulmonary fibrosis (IPF): pirfenidone (Esbriet by Roche, which bought Intermune) and nintedanib (Ofev by Boehringer Ingelheim) on Wednesday October 15. Both drugs will offer new hope for patients, and new pain to the insurance companies and the government who pay for them. Pirfenidone [... read more]

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ICU Physiology in 1,000 Words: Stroke Volume Variation and the Concept of Dose-Response

Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [... read more]

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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]

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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]

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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]

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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]

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