Pulmonary and Critical Care

Bag mask ventilation; use 2 hands

In this single-center cross-over trial of patients undergoing elective surgery, post induction they were administered bag mask ventilation by one- or two-handed techniques; minute ventilation and tidal volumes were significantly higher with the 2 handed technique, indicating superiority of this technique (abstract)

New CPR guidelines issued

The AHA has updated it CPR guidelines, to reflect recent evidence of the benefits of compression-only CPR. The most important change includes the order of CPR, which is now CAB (compressions, airway, breathing), instead of ABC (airway, breathing, compressions). The rate of compressions should be at least 100 per minute, with at least 30 compressions should be completed before assessing airway-breathing. A full copy of the new guidelines can be viewed (AHA site)

COPD follow-up reduces readmissions

In this large cohort of COPD patients, the risk of readmission was 9% lower in those with follow-up within 30 days of discharge (with a PCP or pulmonologist). Higher readmission  rates were observed in those discharged from larger, non-profit, or teaching hospitals. Another study demonstrating the importance of timely follow up to reduce readmission rates (abstract)

Urinary pneumococcal antigen useful in CAP

In this diagnostic trial of patients with community acquired pneumonia (CAP), urinary pneumococcal antigen testing was found to have a positive liklihood ratio of about 20, indicating that a positive result is clinically valuable (and can lead to early tailoring of the antibiotics) (abstract)

Short term neuromuscular blockers good in ARDS

In this trial of 340 ICU patients with ARDS, they were randomized to 48 hours of cisatracurium or placebo. The adjusted in-hospital mortality was lower in the cisatracurium group (hazard ratio 0.68, CI 0.48-0.98). Cisatracurium short term use should be considered in patients with ARDS (abstract)