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Use of the PiCCO system in critically ill patients with septic shock and acute respiratory distress syndrome: a study protocol for a randomized controlled trial.

Trials. 2013;14:32

Authors: Zhang Z, Xu X, Yao M, Chen H, Ni H, Fan H

Abstract
UNLABELLED: ABSTRACT:
BACKGROUND: Hemodynamic monitoring is very important in critically ill patients with shock or acute respiratory distress syndrome(ARDS). The PiCCO (Pulse index Contour Continuous Cardiac Output, Pulsion Medical Systems, Germany) system has been developed and used in critical care settings for several years. However, its impact on clinical outcomes remains unknown.
METHODS/DESIGN: The study is a randomized controlled multi-center trial. A total of 708 patients with ARDS, septic shock or both will be included from January 2012 to January 2014. Subjects will be randomized to receive PiCCO monitoring or not. Our primary end point is 30-day mortality, and secondary outcome measures include ICU length of stay, days on mechanical ventilation, days of vasoactive agent support, ICU-free survival days during a 30-day period, mechanical-ventilation-free survival days during a 30-day period, and maximum SOFA score during the first 7 days.
DISCUSSION: We investigate whether the use of PiCCO monitoring will improve patient outcomes in critically ill patients with ARDS or septic shock. This will provide additional data on hemodynamic monitoring and help clinicians to make decisions on the use of PiCCO.
TRIAL REGISTRATION: http://www.clinicaltrials.gov NCT01526382.

PMID: 23374652 [PubMed - in process]

High-frequency chest wall oscillation successful in controlling refractory asthma.

J Asthma. 2013 Mar;50(2):219-21

Authors: Bose S, Jun J, Diette GB

Abstract
Introduction. High-frequency chest wall oscillation (HFCWO) has been traditionally implemented for airway secretion clearance in conditions such as cystic fibrosis (CF) and bronchiectasis. There have been few reports of its use in refractory asthma. Case report. A 36-year-old, non-smoker male presented with a lifelong history of poorly controlled asthma. Despite multiple controller medications, he reported daily chest congestion, copious phlegm, and frequent exacerbations. Imaging, blood work, and bronchoscopy ruled out atypical infections, immunodeficiency, CF, and other chronic conditions. Pulmonary function tests supported a diagnosis of asthma. Results. We initiated HFCWO therapy twice daily in addition to standard inhaled pharmacological therapy. After 2 months, the patient noted resolution of respiratory symptoms as well as improvement in lung function. He remained symptom-free at his 2-year follow-up. Conclusion. High-frequency chest oscillation may be useful in phenotypes of asthma characterized by prominent mucus hypersecretion.

PMID: 23394251 [PubMed - in process]

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Pleuroscopy in 2013.

Clin Chest Med. 2013 Mar;34(1):81-91

Authors: Lee P, Colt HG

Abstract
Pleuroscopy provides a window to the pleural space while enabling biopsy of the parietal pleura under direct visual guidance for effusions of unknown etiology, guided chest tube placement, and pleurodesis for recurrent pleural effusions or pneumothoraces in selected patients. The procedure enjoyed resurgence when thoracic surgeons introduced the technique for video-assisted thoracic surgery (VATS). VATS is performed under general anesthesia with single-lung ventilation; pleuroscopy is performed in an endoscopy suite using nondisposable rigid or flex-rigid instruments, local anesthesia, and conscious sedation. Pleuroscopy is less invasive; in this review, we discuss the indications, complications, techniques, and recent advances in the procedure.

PMID: 23411059 [PubMed - in process]

Efficacy and safety of indacaterol and tiotropium in COPD patients according to dyspnoea severity.

Pulm Pharmacol Ther. 2013 Feb 19;

Authors: Mahler DA, Buhl R, Lawrence D, McBryan D

Abstract
BACKGROUND: Guidelines for chronic obstructive pulmonary disease (COPD) recommend that treatment choices be based partly on symptoms. METHODS: A post-hoc analysis of pooled data from clinical studies compared the efficacy and safety of once-daily inhaled bronchodilators indacaterol (150 and 300 μg) and open-label tiotropium (18 μg) according to baseline dyspnoea severity on the modified Medical Research Council (mMRC) scale in patients with COPD (mMRC scores <2 = 'less dyspnoea'; scores ≥2 = 'more dyspnoea'). Outcomes were assessed after 26 weeks. RESULTS: The analysis included 3177 patients. In patients with less dyspnoea: indacaterol (both doses) improved 24-h post-dose ('trough') forced expiratory volume in 1 second (FEV(1)), transition dyspnoea index (TDI) and St George's Respiratory Questionnaire (SGRQ) total scores at week 26 and reduced the risk of COPD exacerbations versus placebo; and open-label tiotropium improved trough FEV(1) and TDI total score versus placebo at week 26. In patients with more dyspnoea: indacaterol (both doses) improved trough FEV(1), TDI and SGRQ total scores at week 26; indacaterol 300 μg was the only treatment to improve the TDI total score by more than the minimum clinically important difference (≥1 point) versus placebo; and open-label tiotropium improved trough FEV(1), TDI total score at week 26 and decreased the risk of COPD exacerbations versus placebo. In both subgroups, all treatments were well tolerated. CONCLUSIONS: In patients with less dyspnoea, all treatments had similar effects. Indacaterol 300 μg may be a useful treatment option for patients with COPD who experience more severe breathlessness.

PMID: 23434446 [PubMed - as supplied by publisher]