Pulmonary and Critical Care

“Safe” dose thrombolytics for PE

Concerns continue to exist in using thrombolytics for patients with PE. This trial enrolled patients with symptomatic moderate PE (>70% involvement of at least 2 lobes, or 1 main pulmonary artery). TPA was given as a 10mg bolus, then 40mg over 2 hours (or 0.5mg/kg for those <50kg). After ~2 years, pulmonary HTN was present in 16% of the thrombolytic group and 57% of the control group, mean hospital stay was shorter (2.2 vs 4.9 days), and there were no differences between the groups in mortality or bleeding (abstract).

Trach weaning modalities

In this trial of trach patients weaning from the ventilator, they were randomized to weaning via pressure support, or by unassisted breathing through the trach. Those randomized to unassisted breathing weaned much earlier than the pressure support group (15 versus 19 days) with no difference in mortality between the groups (abstract).

Oscillator more harm than good for ARDS

In this large randomized trial of patients with ARDS, who were randomized to traditional ventilation with low volumes and high PEEP or high frequency oscillator ventilation (HFOV), the trial was stopped early due to higher mortality in the HFOV group. This ventilatory support can not be recommended for patients with ARDS (abstract)

BNP-guided diuresis in ventilated patients

In this trial of ventilated patients, those that were randomized to a BNP-guided diuretic regimen had better diuresis and shorter time on the ventilator (by about a half a day) but no difference in length of stay or mortality (compared to usual care). This appears to be a feasible and effective strategy to reduce ventilator time during weaning (abstract).

No need to monitor gastric residuals in intubated patients

In this trial of patients intubated and receiving tube feedings, they were randomized to measuring gastric residuals or not measuring gastric residuals. Those that did not have their gastric residuals measured had the same risk of VAP, and higher attainment of goal caloric intake, compared to those that did have their residuals measured. This study found no benefit, and potential harm for routinely measuring gastric residuals (abstract).
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