2011 November 25

Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients.

Nov 252011

Risk factors associated with peripherally inserted central venous catheter-related large vein thrombosis in neurological intensive care patients.

Intensive Care Med. 2011 Nov 24;

Authors: Wilson TJ, Brown DL, Meurer WJ, Stetler WR, Wilkinson DA, Fletcher JJ

Abstract
PURPOSE: Using Virchow's triad as a framework, we sought to identify risk factors independently associated with symptomatic peripherally inserted central venous catheter (PICC)-related large vein thrombosis (PRLVT) in neurological intensive care patients. METHODS: A retrospective cohort study and detailed chart review were performed for 431 consecutive PICCs placed in patients admitted to our neurological intensive care unit between March 2008 and February 2010. Variables theorized to potentially increase the risk of PRLVT were abstracted from the medical record. Each variable was then tested for its independent association with PRLVT. RESULTS: During the study period, 431 PICCs were placed with an incidence rate for symptomatic thrombosis of 8.4%. In adjusted analysis, catheter placement in a paretic arm (OR, 9.85; 95% CI, 4.42-21.95), surgery longer than 1 h during dwell time of the catheter (OR, 3.26; 95% CI, 1.48-7.17), a history of venous thromboembolism (OR, 6.66; 95% CI, 2.38-18.62), and mannitol use (OR, 3.27; 95% CI 1.27-8.43) were independently associated with the development of thrombosis. CONCLUSIONS: Alterations in blood flow and consistency, but not vessel injury, appear associated with symptomatic thrombosis following placement of PICCs in neurological intensive care patients. Mannitol use and placement in a paretic arm are potentially modifiable risk factors. Given the high incidence rate of symptomatic thrombosis, future studies should focus on comparing cumulative complications of centrally inserted venous catheters and PICCs in intensive care patients.

PMID: 22113818 [PubMed - as supplied by publisher]

Link to Article at PubMed

Computed tomography scans in severe asthma: utility and clinical implications.

Curr Opin Pulm Med Start a Discussion »

Nov 252011

Computed tomography scans in severe asthma: utility and clinical implications.

Curr Opin Pulm Med. 2011 Nov 23;

Authors: Walker C, Gupta S, Hartley R, Brightling CE

Abstract
PURPOSE OF REVIEW: Asthma is a global burden, affecting 5% of the general adult population, of whom approximately 5-10% suffer from severe asthma. Severe asthma is a complex heterogeneous disease entity, with high morbidity and mortality. Increasingly novel techniques in computed tomography (CT) are being used to understand the pathophysiology of severe asthma. The utility and clinical implications of these CT techniques are the focus of this review. RECENT FINDINGS: Novel qualitative and quantitative CT imaging techniques have enabled us to study the large airway architecture in detail, assess the small airway structure, and perform functional analysis of regional ventilation. SUMMARY: Despite advances in CT imaging techniques, there is an urgent need for both proof-of-concept studies and large cross-sectional and longitudinal clinical trials in severe asthma to validate and clinically correlate imaging derived measures. This will extend our current understanding of the pathophysiology of severe asthma, and unravel the structure-function relationship, with the potential to discover novel severe asthma phenotypes and predict mortality, morbidity, and response to existing and novel pharmacological and nonpharmacological therapies.

PMID: 22112997 [PubMed - as supplied by publisher]

Link to Article at PubMed

Systemic effects of inhaled corticosteroids.

Curr Opin Pulm Med Start a Discussion »

Nov 252011

Systemic effects of inhaled corticosteroids.

Curr Opin Pulm Med. 2011 Nov 23;

Authors: Ernst P, Suissa S

Abstract
PURPOSE OF REVIEW: Although inhaled corticosteroids (ICSs) are the mainstay of therapy in asthma, their use raises certain safety concerns. We review the articles appearing in the last year which have addressed the safety of ICSs when used in the treatment of asthma and chronic obstructive pulmonary disease (COPD). RECENT FINDINGS: Recent studies suggest that patients with asthma as opposed to COPD do not experience an excess risk of pneumonia with ICS use. Patients with respiratory diseases are at increased risk of developing active tuberculosis and this excess risk is exacerbated by the use of high doses of ICSs. ICSs have systemic effects and one result appears to be an increase in the risk of diabetes onset and progression, especially at high doses of ICSs. When examining cases of glaucoma requiring therapy, there was no increase in risk with ICSs even at high current and cumulative doses. Finally, use of even high doses of ICSs during pregnancy does not appear to affect foetal adrenal function. SUMMARY: ICSs are a highly effective therapy in asthma and have an excellent safety profile at the low doses usually required in asthma. Adverse effects appear mostly at higher doses.

PMID: 22112998 [PubMed - as supplied by publisher]

Link to Article at PubMed

November 2011
M	T	W	T	F	S	S
« Oct				Dec »
	1	2	3	4	5	6
7	8	9	10	11	12	13
14	15	16	17	18	19	20
21	22	23	24	25	26	27
28	29	30