Pulmonary and Critical Care

Simple pathway reduces IV antibiotics and LOS in CAP

A simple 3 step pathway (early mobilization, criteria for switching to oral antibiotic, and criteria for hospital discharge) in patients with CAP reduced LOS by 2 days, reduced IV antibiotics by 2 days, and reduced the incidence of adverse drug reactions by 11%, with no change in readmission, mortality, or patient satisfaction scores (abstract)

Self management COPD benefits only the motivated

In this large community based trial of patients post-COPD exacerbation, they were randomized to usual care, or intensive self management  for a year. At the end of a year, overall the self management program was not associated with lower rates of readmissions or deaths, but in the subgroup of patients that were "successful" in the home management program (42% of the intervention group), they had half the risk of readmissions/death compared to those "unsuccessful". The results are encouraging that those compliant with self management can significantly reduce the risk of readmissions / death, but determining in advance who will be motivated to adhere is difficult (abstract)

Add OSA to list of VTE risk factors

In this large cohort of >10,000 patients, although the overall risk of VTE in those with sleep apnea was low (0.5% at 3.5 year follow up), it was significantly higher compared to matched controls (0.2%, hazard ratio ~3) which is even higher in those with sleep apnea on CPAP (hazard ratio ~9). Sleep apnea should be factored into risk prediction of VTE (abstract)

Severe respiratory tract infections? Better ask about sick pets

In this case series, 3 patients with severe pasteurella respiratory infections (epiglottitis and uvulitis with bacteremia, and pneumonia) all had a recent history of taking care of a dying pet (cat or dog). For patients with severe respiratory infections, pet illness should be inquired (abstract)

Colistin back as viable antibiotic for VAP

In this meta-analysis of studies that included colistin in the treatment of VAP, colistin was found to be as effective and as safe as control antibiotics. Given the limited antibiotic pipeline, colistin may be a reasonable alternative for VAP treatment in patients with limited antibiotic options (abstract)