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In This Issue of JAMA
April 5, 2016


JAMA. 2016;315(13):1309-1311. doi:10.1001/jama.2015.14188
Noninvasive Ventilation and Risk of Reintubation in Hypoxemia

In a multicenter trial involving 293 patients who developed hypoxemic respiratory failure within 7 days of abdominal surgery, Jaber and colleagues assessed the risk of reintubation among patients who were randomly assigned to receive standard oxygen therapy vs noninvasive ventilation (NIV) delivered through a face mask. The authors report that use of NIV compared with standard oxygen therapy reduced the risk of tracheal reintubation for any cause within 7 days of treatment assignment. In an Editorial, Spoletini and colleagues discuss the use of NIV or high-flow nasal oxygen for postextubation hypoxemia.

Editorial and Related Article

Continuing Medical Education

Postextubation Oxygen Therapy, Reintubation in Low-Risk Patients

Among mechanically ventilated critically ill patients, high-flow nasal cannula oxygen therapy after extubation improves oxygenation compared with standard oxygen therapy. Conclusive data about rates of reintubation are lacking. In a multicenter randomized trial involving 527 adult patients receiving mechanical ventilation who were scheduled for extubation and at low risk for reintubation, Hernádez and colleagues found that patients randomly assigned to receive high-flow nasal oxygen therapy had lower rates of reintubation at 72 hours than did patients assigned to standard oxygen therapy.

Editorial and Related Article

Pain and Physical Function After Bariatric Surgery

Obesity can be associated with joint pain and physical limitations. King and colleagues assessed changes in pain and physical function in the first 3 years following bariatric surgery in a multicenter cohort study that enrolled 2458 adults undergoing bariatric surgery for severe obesity. The authors found that a large percentage of patients experienced clinically meaningful improvement from baseline in pain, physical function, and walk time over 3 years; however, the percentage of patients with improvement in pain and function decreased in the second and third years following surgery.

Author Video Interview

Clinical Review & Education
Screening for Chronic Obstructive Pulmonary Disease

This US Preventive Services Task Force (USPSTF) Recommendation Statement addresses screening for chronic obstructive pulmonary disease (COPD) in asymptomatic adults who do not recognize or report respiratory symptoms. Based on a review of the evidence on whether screening improves the delivery and uptake of targeted preventive services or improves health outcomes, the USPSTF recommended against screening for COPD in asymptomatic adults. In an Editorial, Martinez and O’Connor discuss population-based screening for unrecognized COPD and case-finding among asymptomatic patients with risk factors.

Editorial and Related Article

Author Audio Interview, JAMA Patient Page, and Continuing Medical Education

Screening for COPD: Evidence Report

Guirguis-Blake and colleagues summarize findings from the US Preventive Services Task Force review of the evidence relating to screening asymptomatic adults for chronic obstructive pulmonary disease (COPD). Thirty-three studies met the criteria for inclusion in the review. The authors found no direct evidence to determine the effectiveness of screening using questionnaires or office-based pulmonary function testing or the benefits of treatment in screen-detected populations.

Editorial and Related Article

Continuing Medical Education

Treatment of Actinic Keratosis

An article in JAMA Dermatology reported that a single course of fluorouracil cream, 5%—applied twice daily for up to 4 weeks—resulted in a reduced number of actinic keratoses for longer than 2 years in a high-risk group of patients. This From The JAMA Network article by Lebwohl discusses treatment options for actinic keratosis.

Postprocedural Blue Toes

Three weeks after undergoing coronary artery bypass graft surgery, a patient presented with altered mental status, acute kidney injury, and dusky discoloration of the distal extremities. He had painful, blue macules and papules on several toes and red macules on his hands. Laboratory examination revealed eosinophilia. What would you do next?