2 Minute Medicine Rewind: May 20 – May 27

May 20 – 27, 2013

In this section, we will highlight the some of the high-impact studies, updates, and analyses published in medicine during the past week.

Prone Positioning in Severe Acute Respiratory Distress Syndrome

In this multicenter RCT (n = 465), patients with moderate to severe ARDS (<150mmHg PaO2/FiO2) were shown to have improved 28-day mortality (16.0% vs. 32.8%) and 90-day mortality (23.6% vs. 41.%) in prone vs. supine position. In the treatment arm, patients were placed in prone position for at least 16 hours per day for up to 28 days with criteria for stopping if clinical status improved. 

Rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisolone in patients with newly diagnosed diffuse large B-cell non-Hodgkin lymphoma: a phase 3 comparison of dose intensification with 14-day versus 21-day cycles

In this multicenter RCT (n = 1080), patients with previously untreated diffuse large B-cell lymphoma were treated with 21 day cycles of R-CHOP for 8 cycles (cyclophosphomide, doxorubicin, vincristine, prednisolone, and rituximab) vs. 14 day cycles of R-CHOP for 6 cycles then two subsequent 14 day cycles of rituximab without significant difference in two year survival (75.4% vs. 74.8%) and similar rates of complication.

A Randomized Trial of Nighttime Physician Staffing in an Intensive Care Unit

In this study of ICUs at UPenn, there was no difference in mortality, ICU length of stay, or total hospital length of stay for patients admitted to the ICU between weeks when a night time intensivist attending was on duty and weeks when a fellow ran the service and the day time intensivist attending was available for consultation by phone. This is consistent with prior studies that suggest night time intensivist staffind did not improve mortality in ICUs with high-intensity day time staffing.

Dupilumab in Persistent Asthma with Elevated Eosinophil Levels

In this study (n = 104), patients with moderate-to-severe asthma with eosinophilia were randomized to weekly subcutaneous dupilumab or placebo and asked to discontinue currently prescribed long-lasting beta-agonists and inhaled glucocorticoids. Twenty-three patients (44%) receiving placebo experienced an asthma exacerbation compared to three patients (6%) receiving weekly dupilumab.

TracMan Trial: Effect of Early vs Late Tracheostomy Placement on Survival in Patients Receiving Mechanical Ventilation

A multicenter RCT of ICUs in the United Kingdom, this study showed there was no 30-day mortality benefit (30.8% vs. 31.5%) or different in ICU length of stay (13.0 vs. 13.1 days) between patients on ventilator support with early vs. late tracheostomy. The study enrolled patients with less than 4 days on ventilator support and thought to require at least 7 more days of ventilator support. In this intention-to-treat analysis, 91.5% of patients randomized to early tracheostomy received a tracheostomy compared to only 44.9% of patients randomized to late tracheostomy.

By David Ouyang

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