Consider The Evidence: Med/Peds Journal Roundup

July 30, 2006

Yes to NO for preemies?

Filed under: NEJM, pediatrics, pulmonary — medblog @ 8:14 pm

NEJM 6/27 – Two articles address the controversial use of inhaled Nitric Oxide in pre-term infants. Prior studies have shown that nitric-oxide may improve gas exchange and lung development in neonates with respiratory failure. Ballard et al. tested this hypothesis on infants weighing less than 1250g, while Kinsella et al. studied all infants less than 34 weeks of age with respiratory failure.

While Ballard et al. found a significant reduction in the incidence of bronchopulmonary dysplasia, the effect size was not large (43.9 vs 36.8) and the P value made it just under the wire at 0.042.

Kinsella et al. found no difference in mortality for the overall group, but did find a significant improvement in outcomes for the group weighing between 1000-1250g, as well as improvement in several secondary outcomes.

Clearly there has to be some futher research into what patients will benefit most from this expensive therapy before it becomes standard of care. 

NEJM Vol. 355(4)


February 1, 2006

PE scoring Ad Nauseam

Filed under: annals of internal medicine, pulmonary, VTE — medblog @ 2:29 am

AnnalsIM 2/7 – This weeks Annals has 2 more articles on PE, didnt they read last weeks Archives? I’ll make this a 2 for 1…
Roy et al. find that ER diagnostic managment of suspected PE was incorrect in 43% of cases. Incorrect management occurred in 57% of those who ruled out and 8% percent of those that had PE.

Le Gal et al. propose a revised Geneva score to stratify pre-test risk for suspected PE. This is different than the old Geneva score in that it does not require an ABG. And unlike the Wells score – there is no need to assess the probablility of alternative diagnoses.

January 31, 2006

Treat and Street the PE

Filed under: archives of internal medicine, pulmonary — medblog @ 9:14 pm

ArchIM 1/23 – Now that we have LMWH in our toolbox, maybe patients can get treatment for pulmonary emboli in the comfort of their own home. Michael Fine, who helped create the mortality prediction rule for CAP, contributes on this Archives article that attempts to find the low-mortality risk subset of patients with PE. Maybe we can start treating these patients as outpatients as well? (more…)

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