In the Literature: Physician Reviews of HM-Related Research

The Hospitalist. 2012 March;2012(03):

March 31, 2012 | The Hospitalist

Daniel M. Kaplan, MD ; Saumil M. Chudgar, MD ; Noppon Setji, MD ; Thomas A. Owens, MD

After multivariate adjustment, those receiving <3.1 L had no increased risk of necrosis or any other adverse outcome, compared with those who received the middle range of fluid volume.

Patients receiving >4.1 L had a higher risk of persistent organ failure (OR: 7.7, 95% CI: 1.5 to 38.7), particularly renal and respiratory insufficiency, and fluid collection development (OR: 1.9, 95% CI: 1 to 3.7) independent of disease severity. Pancreatic necrosis and mortality were similar in the three groups.

Bottom line: Administration of large-volume intravenous fluids (>4.1 L) in

the first 24 hours was associated with worse outcomes, although residual confounding cannot be excluded in this nonrandomized study.

Citation: de-Madaria E, Soler-Sala G, Sanchez-Paya J, et al. Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011;106:1843-1850.

Clinical Outcomes in Saddle Pulmonary Embolism

Clinical question: What are the treatments used and outcomes associated with saddle pulmonary embolism?

Background: Saddle pulmonary embolism is a risk for right ventricular dysfunction and sudden hemodynamic collapse. There are limited data on the clinical presentation and outcomes in these patients.

Study design: Retrospective case review.

Setting: Single academic medical center.

Synopsis: In this retrospective review of 680 patients diagnosed with pulmonary embolism on CT at a single academic medical center from 2004 to 2009, 5.4% (37 patients) had a saddle pulmonary embolism.

Most patients with saddle pulmonary embolism were hemodynamically stable and responded to standard therapy with unfractionated heparin. The mean length of stay was nine days, 46% received an inferior vena cava filter, 41% were treated in an ICU, and 5.4% (two patients) died in the hospital. Thrombolytics were used in only 11% of patients, most of which had sustained hypotension and/or were mechanically ventilated.

Bottom line: Most patients with saddle pulmonary embolus in this single institution study did not receive thrombolytics and had overall low mortality.

Citation: Sardi A, Gluskin J, Guttentag A, Kotler MN, Braitman LE, Lippmann M. Saddle pulmonary embolism: is it as bad as it looks? A community hospital experience. Crit Care Med. 2011;39:2413-2418.

Clinical Shorts

Pancreaticojejunostomy Is Superior To Endoscopy As Treatment For Advanced Chronic Pancreatitis

In this small prospective trial of 31 patients with advanced chronic calcific pancreatitis, patients who initially underwent a pancreaticojejunostomy had less pain and required fewer re-interventions than patients who had endoscopic treatment during a median follow-up of six years.

Citation: Cahen DL, Gouma DJ, Bruna et al. Long-term outcomes of endoscopic vs surgical drainage of the pancreatic duct in patient with chronic pancreatitis. Gastroenterology. 2011;141:1690-1695.

Routine surveillance for patients with Barrett’s esophagus called into question

In this nationwide cohort of patients in Denmark, the annual risk of developing adenocarcinoma in patients with Barrett’s esophagus was 0.12%, which is markedly lower than previously reported estimates of 0.5%, uapon which the guidelines for screening are based.

Citation: Hvid-Jensen F, Pedersen L, Funch-Jensen P, et al. Incidence of adenocarcinoma among patients with Barrett’s esophagus. N Engl J Med. 2012;365:1375-1383.

Consider hepatitis E testing in suspected drug-induced liver injury

A serologic survey of patients in the U.S. with acute liver injury attributed to drugs found 16% had evidence of hepatitis E, representing 3% of the acute disease in the population studied.

Citation: Davern TJ, Chalasani N, Fontana RJ, et al. Acute hepatitis E infection accounts for some cases of suspected drug-induced liver injury. Gastroenterology. 2011;141:1665-1672.

Pressure redistribution mattresses reduce pressure ulcers

A cost-effectiveness analysis supported using pressure redistribution mattresses to prevent pressure ulcers in long-term care residents; additional study is needed to determine the cost-effectiveness of emollients and cleansers.

Citation: Pham B, Stern A, Chen W, et. al. Preventing pressure ulcers in long-term care. Arch Intern Med. 2011;171:1839-1847.

Screening chest x-rays still do not prevent death from lung cancer

A randomized controlled trial of annual screening chest radiography enrolling nearly 155,000 patients, 52% of whom were current or former smokers, yielded no reduction in mortality from lung cancer.

Citation: Oken MM, Hocking WG, Kvale PA, et al. Screening by chest radiograph and lung cancer mortality. JAMA. 2011;306:1865-1873.

Abnormal QT-interval duration is associated with increased mortality

A cross-sectional study found that shortened or prolonged QT-interval duration, even if still within the reference range, is associated with increased mortality risk.

Citation: Zhang Y, Post WS, Dalal D, Blasco-Colmenares E, Tomaselli GF, Guallar E. QT-interval duration and mortality rate. Arch Intern Med. 2011;171:1727-1733.