Pulmonary and Critical Care

5 days steroids fine in COPD

This trial of patients with acute COPD exacerbation were randomized to 5 versus 14 days of steroids and found no difference between the groups in time to next exacerbation (abstract).

Early TPN in ICU patients

This large trial of patients with a relative contraindication for enteral feeds were randomized to early TPN or usual care. There were no differences in the groups in 60 day mortality or LOS, but those on TPN did have a shorter time ventilated and less muscle/fat loss. It is unclear based on this trial if the benefits of early TPN outweigh the risks (abstract)

No benefit to early trach

This large multicenter study of intubated patients randomized them to early (within 4 days) versus late trach (>10 days); 92% and 45% ending up getting a tracy, respectively. There were no differences between the groups in 30 day mortality, 2 year mortality, ICU LOS, or trach-related complications (abstract).

Machines better for CPR

This meta-analysis of 12 studies of out-of-hospital cardiac arrest found that machine-delivered CPR was associated with ~1.5 times the odds of return of spontaneous circulation compared to human CPR. This may also be true for in-hospital arrest but needs further research (abstract).

Following the pulmonary nodule

New updated guidelines provide guidance for what to do when a solitary pulmonary nodule is discovered on imaging. Among the recommendations: Obtain prior imaging; stability over 2 years does not require any further follow up. If no prior imaging for solid nodules <8mm, follow the Fleischner Society guidelines; if solid >8mm assess risk of cancer based on imaging and clinical history and proceed based on guidelines from the ACCP. Subsolid <5mm do not require follow up, but >5mm does. The full guidelines can be found here (guidelines).