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Articles from Other Journals

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Dog Ownership and Cardiovascular Health: Results from the Kardiovize 2030 Project. Maugeri A, Medina-Inojosa JR, Kunzova S, Barchitta M, Agodi A, Vinciguerra M, Lopez-Jimenez F. Mayo Clin Proc Innov Qual Outcomes. 2019 Aug 23;3(3):268-275. (9-16-18).

Analysis of Human Performance Deficiencies Associated with Surgical Adverse Events. Suliburk JW, Buck QM, Pirko CJ, Massarweh NN, Barshes NR, Singh H, Rosengart TK. JAMA Netw Open. 2019 Jul 3;2(7):e198067. (8-5-19)

New Drugs: Where Did We Go Wrong and What Can We Do Better? Wieseler B, McGauran N, Kaiser T. BMJ. 2019 Jul 10;366:l4340. (7-20-19)

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations. Butler CC, Gillespie D, White P, et al. N Engl J Med. 2019 Jul 11;381(2):111-120. (7-12-19)

Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial. Subirà C, Hernández G, Vázquez A. et al. JAMA. 2019;321(22):2175-82. (6-11-19)

Derivation, Validation, and Potential Treatment Implications of Novel Clinical Phenotypes for Sepsis. Seymour CW, Kennedy JN, Wang S, et al. JAMA. 2019 May 19. (5-30-19)

Association of Unrecognized Obstructive Sleep Apnea with Postoperative Cardiovascular Events in Patients Undergoing Major Noncardiac Surgery. Chan MTV, Wang CY, Seet E, et al. JAMA. 2019 May 14;321(18):1788-98. (5-21-19)

CPAP Adherence May Slow 1-Year Cognitive Decline in Older Adults with Mild Cognitive Impairment and Apnea.  Richards KC, Gooneratne N, Dicicco B, et al. J Am Geriatr Soc. 2019 Mar;67(3):558-64. (5-12-19)

Almost Half of Physicians Say EHRs Have Hurt Quality of Care. Frellick M. Medscape. May 01, 2019. (5-2-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1. [Epub ahead of print] (4-15-19)

Association of Positive Airway Pressure Prescription with Mortality in Patients with Obesity and Severe Obstructive Sleep Apnea: The Sleep Heart Health Study. Lisan Q, Van Sloten T, Marques Vidal P, Haba Rubio J, Heinzer R, Empana JP. JAMA Otolaryngol Head Neck Surg. 2019 Apr 11. (4-12-19)

Effect of Glucose Improvement on Spirometric Maneuvers in Patients with Type 2 Diabetes: The Sweet Breath Study. Gutiérrez-Carrasquilla L, Sánchez E, Barbé F, et al. Diabetes Care. 2019 Apr;42(4):617-24. (4-12-19)

Whole-Genome Sequencing of Pharmacogenetic Drug Response in Racially Diverse Children with Asthma. Mak ACY, White MJ, Eckalbar WL, et al. Am J Respir Crit Care Med. 2018 Jun 15;197(12):1552-64. (3-26-19)

Patient Safety Outcomes under Flexible and Standard Resident Duty-Hour Rules and Sleep and Alertness in a Duty-Hour Flexibility Trial in Internal Medicine. Silber JH, Bellini LM, Shea JA, et al. N Engl J Med 2019; 380:905-14 and 915-23. (3-7-19)

Factors Associated with High-Quality Guidelines for the Pharmacologic Management of Chronic Diseases in Primary Care: A Systematic Review. Molino CGRC, Leite-Santos NC, Gabriel FC, et al. JAMA Intern Med. 2019 Feb 18. (2-25-19)

Effect of Titrating Positive End-Expiratory Pressure (PEEP) With an Esophageal Pressure-Guided Strategy vs an Empirical High PEEP-Fio2 Strategy on Death and Days Free from Mechanical Ventilation Among Patients With Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. Beitler JR, Sarge T, Banner-Goodspeed VM, et al. JAMA. 2019 Feb 18. [Epub ahead of print] (2-21-19)

Prevalence, Underlying Causes, and Preventability of Sepsis-Associated Mortality in US Acute Care Hospitals. Rhee C, Jones TM, Hamad Y, et al. JAMA Netw Open. 2019 Feb 1;2(2):e187571. (2-19-19)

Early Use of Norepinephrine in Septic Shock Resuscitation (CENSER): A Randomized Trial. Permpikul C, Tongyoo S, Viarasilpa T, Trainarongsakul T, Chakorn T, Udompanturak S. Am J Respir Crit Care Med. 2019 Feb 1 [Epub ahead of print].  (2-4-19)

A Randomized Trial of E-Cigarettes versus Nicotine-Replacement Therapy. Hajek P, Phillips-Waller A, Przulj D, et al. N Engl J Med. 2019 Jan 30. [Epub ahead of print]. (1-31-19)

Pantoprazole in Patients at Risk for Gastrointestinal Bleeding in the ICU. Krag M, Marker S, Perner A, et al. N Engl J Med. 2018 Dec 6;379(23):2199-2208. (1-30-19)

Comparison of Wait Times for New Patients Between the Private Sector and United States Department of Veterans Affairs Medical Centers. Penn M, Bhatnagar S, Kuy S, Lieberman S, Elnahal S, Clancy C, Shulkin D. JAMA Netw Open. 2019 Jan 4;2(1):e187096. (1-21-19)  

The Importance of Smoking Cessation on Surgical Outcome in Primary Lung Cancer. Fukui M, Suzuki K, Matsunaga T, Oh S, Takamochi K. Ann Thorac Surg. 2019 Jan 2. pii: S0003-4975(18)31871-X. (1-20-19)

FDA Warns About Increased Risk of Ruptures or Tears in the Aorta Blood Vessel With Fluoroquinolone Antibiotics in Certain Patients. US Food and Drug Administration. December 20, 2018. (12/22/18).

Optimizing Home Oxygen Therapy. An Official American Thoracic Society Workshop Report. Jacobs SS, Lederer DJ, Garvey CM, et al. Ann Am Thorac Soc. 2018 Dec;15(12):1369-81. (12-13-18)

FDA Approves First Treatment for Lambert-Eaton Myasthenic Syndrome, A Rare Autoimmune Disorder. FDA News Releast. Available at: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm627093.htm (12-4-18)

Does Point-of-Care Ultrasonography Improve Clinical Outcomes in Emergency Department Patients with Undifferentiated Hypotension? Atkinson PR, Milne J, Diegelmann L, et al. Ann Emerg Med. 2018 Oct;72(4):478-89. (11-8-18)

E-cigarette Use and Subsequent Smoking Frequency Among Adolescents. Barrington-Trimis JL, Kong G, Leventhal AM, et al. Pediatrics. November 05, 2018. [Epub ahead of print] (11-5-18)

Changes in Prevalence of Health Care-Associated Infections in U.S. Hospitals. Magill SS, O'Leary E, Janelle SJ, et al. N Engl J Med. 2018 Nov 1;379(18):1732-1744. (11-1-18)

Benefits and Harms of Antihypertensive Treatment in Low-Risk Patients with Mild Hypertension. Sheppard JP, Stevens S, Stevens R, Martin U, Mant J, Hobbs FDR, McManus RJ. JAMA Intern Med. October 29, 2018. (11-30-18)

Prevalence of Financial Conflicts of Interest Among Authors of Clinical Guidelines Related to High-Revenue Medications. Khan R, Scaffidi MA, Rumman A, Grindal AW, Plener IS, Grover SC. JAMA Intern Med. 2018 Oct 29. and Evaluation of Industry Relationships Among Authors of Clinical Practice Guidelines in Gastroenterology. CombsTR, Scott J, Jorski A, Heavener T, Vassar M. JAMA Intern Med. 2018 Oct 29. (10-30-18).

Baloxavir Marboxil for Uncomplicated Influenza in Adults and Adolescents. Hayden FG, Sugaya N, Hirotsu N, et al. N Engl J Med. 2018 Sep 6;379(10):913-23. (10-25-18)

Assessment of Industry Data on Pulmonary and Immunosuppressive Effects of IQOS. Moazed F, Chun L, Matthay MA, Calfee CS, Gotts J.. Tob Control. 2018 Aug 29. pii: tobaccocontrol-2018-054296. [Epub ahead of print] (9-24-18)

Effect of Aspirin on All-Cause Mortality in the Healthy Elderly. McNeil JJ, Nelson MR, Woods RL, et al. Effect of aspirin on all-cause mortality in the healthy elderly. N Engl J Med. 2018 Sep 16. [Epub ahead of print] (9-20-18)

Improved Empirical Antibiotic Treatment of Sepsis After an Educational Intervention: The ABISS-Edusepsis Study. Ferrer R, Martínez ML, Gomà G, et al. Crit Care. 2018 Jun 22;22(1):167. (8-31-18).

Effect of Azithromycin on Airflow Decline-Free Survival After Allogeneic Hematopoietic Stem Cell Transplant: The ALLOZITHRO Randomized Clinical Trial. Bergeron A, Chevret S, Granata A, et al. JAMA 2017;318(6):557-566. (8-8-18)

Depression, Antidepressant Use, and Risk of Venous Thromboembolism: Systematic Review and Meta-Analysis Of Published Observational Evidence. Kunutsor SK Seidu S, Khunti K. Ann Med. 2018 Jul 12:1-17. (7-30-18)

Electronic Health Records Associated with Lower Hospital Mortality After Systems Have Time to Mature. Lin SC, Jha AK, Adler-Milstein J. Health Aff (Millwood). 2018 Jul;37(7):1128-1135. (7-12-18)

Sodium Bicarbonate Therapy for Patients with Severe Metabolic Acidaemia in the Intensive Care Unit (BICAR-ICU): A Multicentre, Open-Label, Randomised Controlled, Phase 3 Trial. Jaber S, Paugam C, Futier E, et al. Lancet. 2018 Jun 14. pii: S0140-6736(18)31080-8. (7-6-18)

Combined Analysis of Asthma Safety Trials of Long-Acting β2-Agonists. Busse WW, Bateman ED, Caplan AL, Kelly HW, O'Byrne PM, Rabe KF, Chinchilli VM. N Engl J Med. 2018 Jun 28;378(26):2497-2505. (7-5-18)

Continuity of Care with Doctors-A Matter of Life and Death? A Systematic Review of Continuity of Care and Mortality. Pereira Gray D, Sidaway-Lee K, White E, Thorne A, Evans PH. BMJ Open. 2018 Jun 28;8(6):e021161. (7-3-18)

Minimally Invasive Lung Cancer Surgery Performed by Thoracic Surgeons as Effective as Thoracotomy. Boffa DJ, Kosinski AS, Furnary AP, et al. J Clin Oncol. 2018 May 23:JCO2018778977. [Epub ahead of print] (6-30-18)

Serotonergic Antidepressant Use and Morbidity and Mortality Among Older Adults with COPD. Vozoris NT, Wang X, Austin PC, et al. Eur Respir J  2018 Jun 26. [Epub ahead of print] (6-27-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018 Jun 12. [Epub ahead of print] (6-17-18)

Effects on Abstinence of Nicotine Patch Treatment Before Quitting Smoking: Parallel, Two Arm, Pragmatic Randomised Trial. The preloading investigators. BMJ. 2018 Jun 13;361:k2164. (6-15-18)

Associations Between American Board of Internal Medicine Maintenance of Certification Status and Performance on a Set of Healthcare Effectiveness Data and Information Set Process Measures. Gray B, Vandergrift J, Landon B, Reschovsky J, Lipner R. Ann Intern Med. 2018. June 11, 2018. [Epub ahead of print] (6-12-18)

Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Ann Intern Med. 2018 Jun 5. [Epub ahead of print] (6-7-18)

Effect of Increased Inpatient Attending Physician Supervision on Medical Errors, Patient Safety, and Resident Education: A Randomized Clinical Trial. Finn KM, Metlay JP, Chang Y, Nagarur A, Yang S, Landrigan CP, Iyasere C.JAMA Intern Med. 2018 Jun 4 [Epub ahead of print]. (6-6-18)

Adjuvant Chemotherapy Guided by a 21-Gene Expression Assay in Breast Cancer. Sparano JA, Gray RJ, Makower DF, et al. N Engl J Med. 2018; June 3. (6-4-18)

Effect of Use of a Bougie vs Endotracheal Tube and Stylet on First-Attempt Intubation Success Among Patients with Difficult Airways Undergoing Emergency Intubation: A Randomized Clinical Trial. Driver BE, Prekker ME, Klein LR, Reardon RF, Miner JR, Fagerstrom ET, Cleghorn MR, McGill JW, Cole JB. JAMA. 2018 May 16. (6-1-18)

Association of Pharmaceutical Industry Marketing of Opioid Products to Physicians With Subsequent Opioid Prescribing. Hadland SE, Cerdá M, Li Y, Krieger MS, Marshall BDL. JAMA Int Med 2018; May 14. [Epub ahead of print] (5-14-18)

Low-Dose CT for the Diagnosis of Pneumonia in Elderly Patients: A Prospective, Interventional Cohort Study. Prendki V, Scheffler M, Huttner B, et al. Eur Respir J. 2018 Apr 12. pii: 1702375. [Epub ahead of print] (5-4-18)

Nivolumab plus Ipilimumab in Lung Cancer with a High Tumor Mutational Burden. Hellmann MD, Ciuleanu TE, Pluzanski A, et al. N Engl J Med. 2018 Apr 16 [Epub ahead of print] (4-17-18)

Four-gene Pan-African Blood Signature Predicts Progression to Tuberculosis. Suliman S, Thompson E, Sutherland J, et al. Am J Respir Crit Care Med. 2018 Apr 6. [Epub ahead of print] (4-10-18)

A Time-Motion Study of Primary Care Physicians' Work in the Electronic Health Record Era. Young RA, Burge SK, Kumar KA, Wilson JM, Ortiz DF. Fam Med. 2018 Feb;50(2):91-9. (3-28-18)

Impact of Temporary Methotrexate Discontinuation for 2 Weeks on Immunogenicity of Seasonal Influenza Vaccination in Patients with Rheumatoid Arthritis: A Randomised Clinical Trial. Park JK, Lee YJ, Shin K, Ha YJ, et al.  Ann Rheum Dis. 2018 Mar 23. pii: annrheumdis-2018-213222. (3-27-18)

Quantifying Population-Level Health Benefits and Harms of E-Cigarette Use in the United States. Soneji SS, Sung HY, Primack BA, Pierce JP, Sargent JD. PLoS One. 2018 Mar 14;13(3):e0193328. (3-15-18)

Effect of opioid vs nonopioid medications on pain-related function in patients with chronic back pain or hip or knee osteoarthritis pain: The SPACE randomized clinical trial. Krebs EE, Gravely A, Nugent S, et al. JAMA. 2018 Mar 6;319(9):872-82. (3-6-18)

Adolescent Exposure to Toxic Volatile Organic Chemicals from E-Cigarettes. Rubinstein ML, Delucchi K, Benowitz NL, et al. Pediatrics. 2018;141(4):e20173557. (3/5/18)

Electronic Cigarette Use and Progression from Experimentation to Established Smoking. Chaffee BW, Watkins SL, Glantz SA. Pediatrics. 2018;141(4):e20173594. (3/5/18)

Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. Christensen CH, Rostron B, Cosgrove C, et al. Association of Cigarette, Cigar, and Pipe Use With Mortality Risk in the US Population. JAMA Intern Med. 2018 Feb 19. [Epub ahead of print] (2-22-18)

Cleaning at Home and at Work in Relation to Lung Function Decline and Airway Obstruction. Svanes Ø, Bertelsen RJ, Lygre SH, et al.  Am J Respir Crit Care Med. 2018 Feb 16. [Epub ahead of print] (2-20-18)

Long-term Use of Inhaled Corticosteroids in COPD and the Risk of Fracture. Gonzalez AV, Coulombe J, Ernst P, Suissa S. Chest. 2018;153(2):321-8. (2-15-18)

Prevention of Ventilator-Associated Pneumonia: The Multimodal Approach of the Spanish ICU “Pneumonia Zero” Program.  Álvarez-Lerma F, Palomar-Martínez M, Sánchez-García M, et al. Crit Care Med 2018;46:181-8. (2-8-18) 

Progressive Massive Fibrosis in Coal Miners From 3 Clinics in Virginia. Blackley DJ, Reynolds LE, Short C, Carson R, Storey,E, Halldin,CN, Laney AS. JAMA 2018;319(5):50-1. (2-6-18)

Low cigarette consumption and risk of coronary heart disease and stroke: meta-analysis of 141 cohort studies in 55 study reports. Hackshaw A,  Morris JK, Boniface S, Tang JL, Milenković D. BMJ. 2018;360:j5855. (1-27-18)

Comparison of observed harms and expected mortality benefit for persons in the veterans health affairs lung cancer screening demonstration project. Caverly TJ, Fagerlin A, Wiener RS, Slatore CG, Tanner NT, Yun S, Hayward R. JAMA Intern Med. 2018 Jan 22. [Epub ahead of print] (1-22-18)

Risk of thromboembolism in cisplatin versus carboplatin-treated patients with lung cancer. Kim ES, Baran AM, Mondo EL, et al. PLoS One. 2017 Dec 11;12(12):e0189410. (1-8-18)

Association of cardiovascular risk with inhaled long-acting bronchodilators in patients with chronic obstructive pulmonary disease: A nested case-control study. Wang MT, Liou JT, Lin CW, Tsai CL, Wang YH, Hsu YJ, Lai JH. JAMA Intern Med. 2018 Jan 2. [Epub ahead of print] (1-5-18)

Previously selected articles that were thought important but had received little attention were summarized under our “News” section. However, the work of publication (review, DOAJ, doi, social media, etc.) has become too arduous to do justice to these publications. Therefore, we are beginning a new section titled “News from Other Journals” where selected articles are briefly summarized. Important articles that are published in journals commonly read by pulmonologists, intensivists or sleep physicians will not necessarily be reviewed but articles that are in general medicine journals or lower impact journals that might be of interest to the practicing physician are selected. As always, there will be links to the article via CrossRef and/or PubMed.

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Tuesday
Sep172019

Dog Ownership and Cardiovascular Health: Results from the Kardiovize 2030 Project

Maugeri A, Medina-Inojosa JR, Kunzova S, Barchitta M, Agodi A, Vinciguerra M, Lopez-Jimenez F. Mayo Clin Proc Innov Qual Outcomes. 2019 Aug 23;3(3):268-275. [CrossRef] [PubMed]

In Arizona an automobile license can be obtained which says, “Pets Enrich Our Lives”. This article suggests that pet ownership may have health benefits. The authors studied 1769 subjects (aged from 25 to 64 years; 44.3% males) with no history of cardiovascular disease and compared cardiovascular health (CVH) scores with nonpet owners. Approximately 42% of subjects owned a pet: 24.3% owned a dog and 17.9% owned another animal. Pet owners, and specifically dog owners, were more likely to report physical activity, diet, and blood glucose at ideal level which resulted in higher CVH score than nonpet owners (P=0.006). Compared with owners of other pets, dog owners were more likely to report physical activity and diet at ideal level. The comparison of dog owners with non-dog owners yielded similar results. After adjustment for covariates, dog owners exhibited higher CVH scores than non-pet owners (P=0.005), other pet-owners (0.309; P=0.041), and non-dog owners (P=0.004). The authors conclude that dog owners were more likely to achieve recommended level of behavioral CVH metrics (physical activity and diet) than non-dog owners, which likely translates into better cardiovascular health.

Monday
Aug052019

Analysis of Human Performance Deficiencies Associated with Surgical Adverse Events

Suliburk JW, Buck QM, Pirko CJ, Massarweh NN, Barshes NR, Singh H, Rosengart TK. JAMA Netw Open. 2019 Jul 3;2(7):e198067. [CrossRef] [PubMed]

Potentially preventable adverse events remain a formidable cause of patient harm and health care expenditure despite advances in systems-based risk-reduction strategies. The authors analyzed the incidence of human performance deficiencies (HPDs) during the provision of surgical care using a new taxonomy to inform the development and implementation of an HPD classifier tool to categorize HPDs into errors associated with cognitive, technical, and team dynamic functions. The HPD classifier tool was then used to concurrently analyze surgical adverse events in 3 adult hospital affiliates—a level I municipal trauma center, a quaternary care university hospital, and a US Veterans Administration hospital—from January 2, 2018, to June 30, 2018. Surgical trainees presented data describing all adverse events associated with surgical services at weekly hospital-based morbidity and mortality conferences.

A total of 188 adverse events were recorded, including 182 adverse events (96.8%) among 5365 patients who underwent surgical operations and 6 adverse events (3.2%) among patients undergoing nonoperative treatment. Among these 188 adverse events, 106 (56.4%) were associated with HPDs. Among these 106 HPD adverse events over half were attributed to human performance deficiencies in execution, planning or problem solving, communication, teamwork, and rules violation. Among the adverse events listed in Table 1 of the article were surgical site infection and wound dehiscence (12.2%); unexpected bleeding or transfusion (8%); deep venous thrombosis and pulmonary embolism (6.4%); unplanned intubation, pneumonia, and the patient needing a ventilator more than 48 hours after the operation has ended (5.9%), sepsis or septic shock (4.3%).

The authors conclude that human performance deficiencies were identified in more than half of adverse events, most commonly associated with cognitive error in the execution of care. It is unclear how many of these adverse events relate to human performance deficiencies including cognitive error.

Saturday
Jul202019

New Drugs: Where Did We Go Wrong and What Can We Do Better?

Wieseler B, McGauran N, Kaiser T. BMJ. 2019 Jul 10;366:l4340. [CrossRef] [PubMed]

The authors reviewed the efficacy of new medications approved in Germany. Medicine regulators around the world are pursuing a strategy aimed at accelerating the development and approval of drugs. These approaches are based on the assumption that faster access to new drugs benefits patients. The rhetoric of novelty and innovation creates an assumption that new products are better than existing ones.

But although gaps in the therapeutic armamentarium undoubtedly exist, research covering drug approvals since the 1970s suggests only a limited number of new drugs provide real advances over existing drugs. Most studies put the proportion of true innovation at under 15%, with no clear improvement over time.

In one large study, investigators found that only 54 (25%) of the 216 new drugs entering the German market between 2011 and 2017 were judged to have a considerable, or major, added benefit. For 16% of these new agents, this additional benefit was either minor or could not be quantified. In addition, for 58% of these medications there was no proof of added benefit vs.  standard of care in the approved patient population.

"Rather than waiting for drug companies to decide what to develop, they could define the health system's needs and implement measures to ensure the development of the treatments required," they write, adding that this could include needs-oriented public-private partnerships and not-for-profit drug development.

In response to the article, the Association of Research-Based Pharmaceutical Companies in Germany issued a statement pointing out that the assessment of additional benefit "is not an easy matter — there is not always a 'right' or 'wrong.'"

Friday
Jul122019

C-Reactive Protein Testing to Guide Antibiotic Prescribing for COPD Exacerbations

Butler CC, Gillespie D, White P, et al. N Engl J Med. 2019 Jul 11;381(2):111-120. [CrossRef] [PubMed]

Point-of-care testing of C-reactive protein (CRP) may be a way to reduce use of antibiotics in patients who have acute exacerbations of chronic obstructive pulmonary disease (COPD). The authors performed a multicenter, open-label, randomized, controlled trial involving patients with a diagnosis of COPD. The patients were assigned to receive usual care guided by CRP point-of-care testing (CRP-guided group) or usual care alone (usual-care group). The primary outcomes were patient-reported use of antibiotics for acute exacerbations of COPD within 4 weeks after randomization (to show superiority) and COPD-related health status at 2 weeks after randomization, as measured by the Clinical COPD Questionnaire, a 10-item scale with scores ranging from 0 (very good COPD health status) to 6 (extremely poor COPD health status) (to show noninferiority). A total of 653 patients underwent randomization. Fewer patients in the CRP-guided group reported antibiotic use than in the usual-care group (57.0% vs. 77.4%; adjusted odds ratio, 0.31; 95% confidence interval [CI], 0.20 to 0.47). The adjusted mean difference in the total score on the Clinical COPD Questionnaire at 2 weeks was −0.19 points (two-sided 90% CI, −0.33 to −0.05) in favor of the CRP-guided group. The authors conclude that CRP-guided prescribing of antibiotics for exacerbations of COPD in primary care clinics resulted in a lower percentage of patients who reported antibiotic use and who received antibiotic prescriptions from clinicians, with no evidence of harm.

Tuesday
Jun112019

Effect of Pressure Support vs T-Piece Ventilation Strategies During Spontaneous Breathing Trials on Successful Extubation Among Patients Receiving Mechanical Ventilation: A Randomized Clinical Trial

Subirà C, Hernández G, Vázquez A. et al. JAMA. 2019;321(22):2175-2182. [CrossRef]

Daily spontaneous breathing trials (SBTs) are the best approach to determine whether patients are ready for disconnection from mechanical ventilation, but mode and duration of SBT remain controversial. The authors randomized patients to undergo a 2-hour T-piece SBT (n = 578) or a 30-minute SBT with 8-cm H2O pressure support ventilation (n = 557). Among 1153 patients who were randomized successful extubation occurred in 473 patients (82.3%) in the pressure support ventilation group and 428 patients (74.0%) in the T-piece group (difference, 8.2%; 95% CI, 3.4%-13.0%; P = .001). Reintubation, median intensive care unit length of, and median hospital length of stay did not differ but hospital mortality was lower for pressure support (10.4% vs 14.9%, P = .02) as was 90-day mortality was (13.2% vs 17.3%, P = .04). The authors conclude that among patients receiving mechanical ventilation, a spontaneous breathing trial consisting of 30 minutes of pressure support ventilation, compared with 2 hours of T-piece ventilation, led to significantly higher rates of successful extubation. These findings support the use of a shorter, less demanding ventilation strategy for spontaneous breathing trials.