Hot in CHEST: November 2014
November 19, 2014
Each month, we ask Drs. Chris Carroll and Deep Ramachandran, Social Media Co-Editors of CHEST, to weigh in on the hot topics in CHEST. It’s November, so let’s hear from Dr. Ramachandran as he outlines his highlights from the November issue. After reviewing the issue, what’s on your hot list? Be sure to share on our Facebook wall, tweet with the hashtag #NovCHEST, or discuss in the CHEST e-Community!
By: Deep Ramachandran, MBBS
Do We Really Need Arterial Lines in the ICU?
I’ve heard from ICU residents that a colleague of mine, when discussing whether patients need an arterial catheter, likes to say (and I’m paraphrasing): “No one has ever died because they didn’t have an arterial line.” The article in CHEST states the inherent question in that statement more clearly. Placements of arterial catheters have become a mainstay of monitoring in the ICU environment despite a paucity of data on the subject. Dr. Garland draws some interesting parallels between the current use of arterial catheters and the widespread use of pulmonary artery catheters in the 1990s. Could arterial lines one day fall out of favor the way pulmonary artery catheters have?
New Onset Atrial Fibrillation in Sepsis Has Long-term Implications“Doctor, his heart rate is up to 140 and the rate is irregular,” so goes the call critical care physicians often receive in the middle of night. It’s often followed by the usual protocol of treatment for atrial fibrillation. Atrial fibrillation is common among patients with sepsis, and its management is often routine. But the study by Dr. Walkey and colleagues suggests that this may need to be looked at more closely. They found that patients with a new onset of atrial fibrillation have a higher rate of recurrence after hospitalization compared with those without atrial fibrillation. This risk is accompanied by a higher risk of recurrent risk of hospitalization due to heart failure.
We Need to Rethink CPR in Elderly With Chronic Disease
Patients and families often request CPR and life support if the heart stops or breathing ceases. They often imagine scenes from medical dramas wherein doctors (usually good-looking ones) perform a few chest compressions, administer a few drugs, and bring the patients back to life. This is often followed by high-fives, going out for drinks, and participation in strange love triangles. Unfortunately, art does not always imitate life and the drama in such scenes is as unreal as the patient outcomes. This is borne by the study by Dr. Stapleton and colleagues . Their study shows that survival in patients undergoing in-hospital CPR is poor. In total, only 17% of all patients survived CPR in the hospital. Among those who were discharged, long-term survival among patients classified as having a severe form of numerous disease states, including COPD, CHF, CKD, and others, was dismal. Having this data available would prove useful when educating patients and families about what really happens after CPR.