Terence K. Trow

Surviving Pulmonary Hypertension: An Oral Alternative?

Synopsis: New oral alternatives exist for the treatment of pulmonary arterial hypertension in the form of endothelin receptor blockers. Data on survival collected from September 1999 to December 2002 suggest that use of one such agent, bosentan, may be as effective in improving survival in patients with advanced hypertension as previously studied intravenous alternatives. Source: McLaughlin VV et al. Survival with first line bosentan in patients with primary pulmonary hypertension. Eur Respir J. 2005;25:244–249.

???Best PEEP??? Therapy in the Injured Lung

Synopsis: In a randomized, prospective trial of 549 patients ventilated with a tidal volume of 6 mL/kg and plateau pressures 30 centimeters (cm) of water pressure, no difference in outcome could be demonstrated between low (8.3-cm water pressure) and high (13.2-cm water pressure) positive end expiratory pressure strategies. Source: The National Heart, Lung, and Blood Institute ARDS Clinical Trials Network. Higher versus lower PEEP in patients with the acute respiratory distress syndrome. N Engl J Med. 2004;351:327-336.

Live ???Free??? or Die: Total or Free Serum Cortisol Measure in the Critically Ill

Synopsis: The interpretation of baseline and cosyntropin-stimulated serum total cortisol should be done with respect to the patient’s protein status, since hypoproteinemia results in lower-than-expected concentrations of serum total cortisol in critically ill patients, despite an adequate adrenal response as evidenced by measurement of serum free cortisol levels. Source: Hamrahian A et al. Measurements of serum free cortisol in critically ill patients. N Engl J Med. 2004;350:1629-1638.