Peter Spiegler

• Winthrop University Hospital

Context: Given the high mortality of 30-60% associated with septic shock, distinguishing which patients do or do not have a reasonable chance of surviving with aggressive treatment could help clinicians and families make informed decisions. Objectives: To determine if intensity of vasopressor therapy accurately predicts in-hospital death. Metho...

SESSION TITLE: Sepsis & Septic Shock Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM PURPOSE: Septic shock is the most common cause of death in the intensive care unit, exhibiting a mortality rate of 40 to 60%. Several studies have compared mortalities associated with different va...

SESSION TYPE: Critical Care Case Report PostersPRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PMINTRODUCTION: ABG analysis is required to measure important parameters in critically ill patients, including co-oximetry. Clinicians should be aware of the limitations on the test.CASE PRESENTATION: We present a case of a 44 year-old woman a...

Patients with chronic respiratory disorders are characterized by progressive dyspnea, exercise intolerance and impaired quality of life. For many of these patients, medical therapy usually results in only partial relief of symptoms. Pulmonary rehabilitation has emerged as an important tool in helping these patients achieve higher levels of activity...

Eosinophilic pneumonia is characterized by cough, lung infiltrates on imaging, and by the presence of eosinophils in the alveoli and pulmonary interstitium. Azacitidine, a pyramidine nucleoside analog of cytidine, is FDA approved for the treatment of various myelodysplastic syndromes. We present a case of a 76-year-old man with recently diagnosed m...

Synopsis: Patients with overlap syndrome of obstructive sleep apnea and chronic obstructive pulmonary disease (COPD) had a higher risk of hospitalization from COPD exacerbation than patients with COPD alone. Mortality was higher in those patients with overlap syndrome who refused continuous positive airway pressure therapy. Source: Marin JM, Sorian...

Synopsis: Combination of inhaled glucocorticoids and tiotropium resulted in improved symptoms and lung function in uncontrolled asthma. Source: Peters SP, Kunselman SJ, Icitovic N, et al. Tiotropium bromide step-up therapy for adults with uncontrolled asthma. N Engl J Med. 2010;363:1715–1726.

Synopsis: An analysis of the long-term outcomes and costs of patients requiring prolonged mechanical ventilation. Source: Unroe M, Kahn JM, Carson SS, et al. One-year trajectories of care and resource utilization for recipients of prolonged mechanical ventilation. Ann Intern Med. 2010;153:167–175.

Chronic lung diseases are typically associated with impaired quality of life, stress, and anxiety. Written disclosure therapy (WDT) reduces stress in patients with a variety of chronic illnesses. We sought to determine whether WDT benefits patients with chronic lung disease. A prospective, randomized, controlled trial was performed to evaluate the...

Synopsis: Half the standard dose of tissue plasminogen activator for pulmonary embolism exhibits similar efficacy and perhaps better safety in patients with acute pulmonary embolism. Source: Wang C, Zhai Z, Yang Y, et al. Efficacy and safety of low-dose recombinant tissue-type plasminogen activator for the treatment of acute pulmonary thromboemboli...

Synopsis: For patients who develop hypercapnea during a spontaneous breathing trial, extubation directly to noninvasive ventilatory support reduces the risk of postextubation respiratory failure. Source: Ferrer M, Sellares J, Valencia M, et al. Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders: ran...

Synopsis: A randomized controlled trial of lung cancer screening in smokers aged 60 to 74 years with annual CT scans showed no mortality benefit in short term follow-up. Source: Infante M, Cavuto S, Lutman FR, et al. A randomized study of lung cancer screening with spiral computed tomography: three-year results from the DANTE trial. Am J Respir Cri...

Patients with bronchiectasis experience tenacious mucus, recurrent infectious exacerbations, and progressive worsening of symptoms and obstruction over time. Treatment is aimed at trying to break the cycle of infection and progressive airway destruction. Antibacterial treatment is targeted towards likely organisms or tailored to the results of sput...

Bronchiectasis is an under-appreciated cause of chronic lung disease in the USA. We highlight developments in diagnosis and treatment of this debilitating disease. A possible link between gastroesophageal reflux and development of nontuberculous mycobacterial lung disease was highlighted. Reflux is more common in patients with nontuberculous mycoba...

PURPOSE: To determine whether CTPA accurately portrays right ventricular (RV) and pulmonary artery (PA)dilatation and to correlate these findings with echocardiographic data in patients with central PE. METHODS: We retrospectively reviewed data of consecutive patients with central PE diagnosed by CTPA at our institution over a 3 year period. We rec...

PURPOSE: A review of the diagnostic studies performed in the evaluation of suspected venous thromboembolism (VTE) in obstretical patients at a tertiary care center. METHODS: A retrospective review of all obstetrical patients undergoing either ventilation-perfusion (VQ) scanning, computerized tomographic pulmonary angiography (CTPA), or venous duple...

Pulmonary hyalinizing granulomata are rare, noninfectious, fibrosing lesions of the lung, which can mimic metastatic disease radiographically. Their etiology is unknown, but they may be caused by an exaggerated immune response. We report the radiology, long clinical course, and pathology of a patient with pulmonary hyalinizing granuloma who present...

Synopsis: A large epidemiologic study of empyema demonstrates that the microbiology differs from pneumonia and has prognostic significance. Source: Maskell NA, Batt S, Hedley EL, et al. The bacteriology of pleural infection by genetic and standard methods and its mortality significance. Am J Respir Crit Care Med. 2006;174:817-823.

PURPOSE: To review the presentation and management of patients with central pulmonary embolism (PE) at a University Medical Center. Central PE was defined as clot in the main pulmonary artery or multiple lobar branches. METHODS: We retrospectively reviewed the records of consecutive patients with central PE detected by CT pulmonary angiography (CTP...

Synopsis: An examination of the effects of positive end-expiratory pressure on lung recruitment was studied using computed tomographic imaging. Source: Gattinoni L, Caironi P, Cressoni M, et al. Lung recruitment in patients with the acute respiratory distress syndrome. N Engl J Med. 2006;354:1775-1786.

Although pulmonary rehabilitation results in improvement in multiple outcome areas, relatively few studies in the United States have evaluated its effect on healthcare utilization. This study compared aspects of healthcare utilization during the year before to the year after outpatient pulmonary rehabilitation in patients with chronic obstructive p...

Synopsis: Despite beneficial effects on secondary outcomes, the use of continuous positive airway pressure for central sleep apnea in congestive heart failure had no effect on survival. Source: Bradley TD, Logan AG, Kimoff RJ, et al. Continuous positive airway pressure for central sleep apnea and heart failure. N Engl J Med. 2005;353:2025–2033.

To determine whether there is any difference in the effect of pulmonary rehabilitation (PR) on outcomes in patients with and without chronic obstructive pulmonary disease (COPD). Retrospective analysis of medical records of all patients enrolling in PR over a 5-year period. A total of 422 patients enrolled in a multidisciplinary PR program from Aug...

Synopsis: Computed tomography (CT) screening for lung cancer results in many false-positive results but does not produce a stage shift or change in mortality. Source: Swensen SJ, Jett JR, Hartman TE, et al. CT screening for lung cancer: five-year prospective experience. Radiology. 2005;235:259–265.

Synopsis: Oral appliances, which serve to advance the mandible anteriorly in patients with obstructive sleep apnea, are a viable therapeutic option which not only reduces the symptoms of sleep disordered breathing but also results in improvements in systemic blood pressure. Source: Gotsopoulos H et al. Oral appliance therapy reduces blood pressure...

Synopsis: Measurements of secondhand smoke concentrations can be used to help enforce smoking bans. Source: Navas-Acien A, Peruga A, Breysse P, et al. Secondhand tobacco smoke in public places in Latin America, 2002-2003. JAMA. 2004;291:2741-2745.

Synopsis: An animal model demonstrated the value of photon emission computed tomography in the diagnosis of venous thromboembolism. Source: Morris TA et al. Single photon emission computed tomography of pulmonary emboli and venous thrombi using anti-D-dimer. Am J Respir Crit Care Med. 2004;169:987-993.

Synopsis: Obstructive sleep apnea (OSA) may independently affect insulin sensitivity, and the use of continuous positive airway pressure (CPAP) for OSA may improve insulin sensitivity. This beneficial effect may be present after as little as 2 days of therapy, perhaps occurring through the mechanism of diminished sympathetic drive. Source: Harsch I...

Synopsis: The use of gefitinib (Iressa), an oral epidermal growth factor receptor inhibitor, improves outcome in patients with non-small-cell lung cancer who remain symptomatic after treatment with chemotherapy. Source: Kris et al. Efficacy of gefitinib, an inhibitor of the epidermal growth factor receptor tyrosine kinase, in symptomatic patients w...