AAO-HNS Releases New Guidelines on Tonsillectomy in Children

By Eric Gantwerker MD, MMSc (MedEd), FACS
May 23, 2019

Recently the American Academy of Otolaryngology-Head and Neck Surgery updated their clinical practice guidelines (CPG) on Tonsillectomy in Children (Mitchell et al., 2019). As more studies are published, a periodic review of the literature is necessary.  The last CPG was released in 2011 (Baugh et al., 2011). Since that time 2,190 studies have been indexed in PubMed under the search term “pediatric sleep apnea” with over half of those occurring just since 2016 (1140) (“US National Library of Medicine – NCBI PubMed,” n.d.). Continue reading “AAO-HNS Releases New Guidelines on Tonsillectomy in Children”

Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure

By Connor Emdin
September 26, 2018

Over the past thirty years, survival after the diagnosis of heart failure has improved, with five-year mortality falling from 57% in 1979 to 1984 to 48% in 1996 to 2000.1 Much of this reduction in mortality has been due to the development of novel therapeutics for treatment of heart failure.2 Large randomized clinical trials have demonstrated that angiotensin-converting enzyme inhibitors (ACEIs), angiotensin receptor blockers (ARBs), angiotensin receptor neprilysin inhibitors (ARNIs), beta-blockers (BBs) and mineralcorticoid receptor antagonists (MRAs) all reduce the risk of death and re-hospitalization among patients with heart failure with reduced ejection fraction (HFrEF).2 Current guidelines strongly recommend that all eligible patients with HFrEF be treated with a combination of these agents.2 Continue reading “Use of Guideline-Recommended Medical Therapy in Patients with Heart Failure”

Restrictive versus Liberal Fluid Therapy in Abdominal Surgery

By Connor Emdin
August 28, 2018

Abdominal surgery can result in significant fluid loss, arising from multiple sources, including fasting prior to surgery, evaporation during surgery, from blood loss and from other sources.1 Traditionally, individuals undergoing abdominal surgery received liberal fluid resuscitation (up to 7L on the day of surgery) which frequently exceeded their losses and led to weight gain of 3-6kg.2 Excessive fluid loading can lead to elevated rates of postoperative heart failure, arrhythmias, and wound infection due to local tissue edema, and in small clinical trials, restrictive hydration strategies (targeting net zero fluid balance) have been associated with fewer complications than liberal fluid replacement.3 Consequently, clinical guidelines now recommend more restrictive fluid therapy for abdominal surgery.4,5 Continue reading “Restrictive versus Liberal Fluid Therapy in Abdominal Surgery”

Mortality Prediction in Community-Acquired Pneumonia: The end of the road for SIRS?

By Martina McGrath, MD
December 19, 2017

In 2016, new consensus guidelines were issued for the clinical criteria for sepsis.1 The qSOFA score, incorporating tachypnea, low blood pressure and altered mental status, was proposed as a rapid, bedside assessment, and an alternative to SIRS criteria, to identify patients at high risk of adverse outcomes. Continue reading “Mortality Prediction in Community-Acquired Pneumonia: The end of the road for SIRS?”

Oxygen in Acute MI: Lack of Benefit and Possible Risk?

By Martina McGrath, MD
November 3, 2017

Acute myocardial infarction occurs where there is insufficient supply of oxygenated blood to an area of the heart, leading to myocardial injury and cell death. For decades, clinical guidelines have recommended the administration of supplemental oxygen as a first-line therapy for all patients experiencing myocardial ischemia, regardless of oxygen saturation.1 Continue reading “Oxygen in Acute MI: Lack of Benefit and Possible Risk?”

qSOFA: A New Tool to Identify Early Sepsis

Updated Consensus Definitions for Sepsis—Emphasis on End-Organ Dysfunction

By Martina M. McGrath, MD
January 19, 2017

In February 2016, a joint task force comprised of members of the Society of Critical Care Medicine and the European Society of Intensive Care Medicine published new consensus definitions of sepsis and septic shock. The aim was to reflect an updated understanding of the pathophysiology of sepsis and to develop a clinical tool to allow rapid identification of patients at risk of increased mortality. Several points worthy of note are outlined below: Continue reading “qSOFA: A New Tool to Identify Early Sepsis”

New Guidelines for Statin Treatment

Statins for Prevention of Cardiovascular Disease in Adults

By Martina M. McGrath, MD
December 22, 2016

Cardiovascular disease (CVD) remains the leading killer of adults in the US, implicated in one out of every three deaths. Statins have shown significant benefit in secondary prevention of cardiovascular disease and mortality across a range of patient populations. Despite a large body of work, the data for primary prevention is less clear. Until now, the US Preventive Services Task Force (USPSTF) has not recommended statin therapy for primary prevention of CVD, but has instead suggested monitoring lipid levels as part of an overall CV risk assessment.  In November 2016, they produced a set of recommendations published in JAMA, along with several accompanying editorials. Patients with LDL cholesterol >190mg/dL and those with familial hypercholesterolemia are excluded as statin therapy is recommended with this degree of hyperlipidemia. Lifestyle modification advice is recommended for all patients. Continue reading “New Guidelines for Statin Treatment”