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You are here: Home / Archives for Josh Farkas

PulmCrit Wee: High-titer convalescent plasma fails again for hospitalized COVID patients

March 13, 2021 by Josh Farkas 1 Comment

Convalescent plasma use against epidemic respiratory viruses dates back to the influenza pandemic of 1918.  This intervention has persisted for over a century based on high face-validity, rather than any high-quality evidence.  The COVID epidemic reignited enthusiasm for this therapy, leading to its use in tens of thousands of patients (e.g., an expanded-use program organized […]

IBCC – Acute Liver Failure

March 8, 2021 by Josh Farkas 5 Comments

Acute liver failure is rare, but when it does occur it requires an organized diagnostic and therapeutic approach.  Success often relies upon aggressive support of other organs (e.g. renal failure and management of intracranial hypertension). The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes

IBCC – Spontaneous Bacterial Peritonitis

March 6, 2021 by Josh Farkas 1 Comment

Spontaneous bacterial peritonitis is an important consideration for any hospitalized patient with substantial ascites.  Patients can have minimal symptoms.  To complicate matters further, in some cases spontaneous bacterial peritonitis may present with failure of other organs (e.g. hepatic encephalopathy, or disseminated intravascular coagulation leading to gastrointestinal hemorrhage). The IBCC chapter is located 👉 here. The […]

IBCC – Invasive candidiasis

March 1, 2021 by Josh Farkas 2 Comments

Invasive candidiasis is growing more common in the ICU, as our patients are becoming increasingly complex, with longer stays.  However, most isolation of Candida in the ICU represents colonization rather than infection – so there is a major risk of overdiagnosis resulting in unnecessary medication toxicity and antimicrobial resistance. The IBCC chapter is located 👉 here. […]

IBCC – Hepatorenal Syndrome

February 22, 2021 by Josh Farkas 4 Comments

We’ve been seeing a lot of decompensated liver disease recently, likely related to increases in alcohol intake due to the COVID pandemic.  Over the next month, several chapters on critical care hepatology be released, exploring how to manage these patients.  We start with hepatorenal syndrome and hepatorenal physiology, because this is often the crux of […]

IBCC – Coagulation management in cirrhosis

February 15, 2021 by Josh Farkas 2 Comments

Cirrhosis causes a derangement of all components of coagulopathy.  Fortunately, these derangements tend to balance one another out (so the best approach is often to merely observe).  However, sometimes imbalances may spin out of control and require aggressive management (e.g. causing hyperfibrinolysis with refractory bleeding). The IBCC chapter is located 👉 here. The podcast & […]

PulmCrit – RECOVERY confirms benefit of toci combined with dexamethasone

February 12, 2021 by Josh Farkas 16 Comments

The RECOVERY trial just released a preprint demonstrating benefit from tocilizumab in COVID-19.  As with the prior RECOVERY studies, this is a multicenter, open-label, pragmatic trial.  A robust mortality benefit was detected (the fragility index calculates to 17, which isn’t too shabby).  Several important secondary endpoints were positive as well (e.g., reduced intubation rate, reduced […]

IBCC chapter & cast – Atrial Fibrillation in critical illness

February 8, 2021 by Josh Farkas 8 Comments

Most available data on atrial fibrillation pertains to chronic outpatient management or atrial fibrillation following cardiac surgery.  This data may not apply perfectly to most critically ill patients.  Extrapolation of available data to the management of critically ill patient is challenging, with much left to clinical judgement. The IBCC chapter is located 👉 here. The […]

PulmCrit Wee – MENDS2: Fentanyl or fentanyl for sedation in mechanically ventilated adults with sepsis

February 2, 2021 by Josh Farkas 2 Comments

The MENDS2 trial was intended as a study comparing dexmedetomidine to propofol. However, the doses of these medications used in the study weren’t high enough to be impactful. In retrospect, the study may actually be an investigation of how clinicians approach the agitated intubated patient – potentially revealing an over-reliance on opioid infusions.

PulmCrit Wee – Follow-up Bamlanivimab study unmasks statistical chicanery

January 26, 2021 by Josh Farkas 4 Comments

Whether or not you have any interest in bamlanivimab, you should read this post as an amusing example of shoddy statistics being published in top journals.  background & general landscape of the two trials The BLAZE-1 trial involved randomizing patients within three days of testing positive for COVID-19 to one of four arms:  placebo, 700 […]

IBCC – Revamped COVID chapter focusing on ICU & stepdown management

January 25, 2021 by Josh Farkas 6 Comments

The COVID chapter has been updated, overhauled, and refocused on the management of the sickest COVID patients (those requiring admission to ICU or stepdown units).  The new chapter removes more basic information about COVID that we’re all probably familiar with at this point (but the original, larger chapter is still available here). The goal of […]

IBCC chapter – Disseminated Intravascular Coagulation (DIC)

January 18, 2021 by Josh Farkas 1 Comment

Disseminated Intravascular Coagulation (DIC) is like the ARDS of the hematological system.  It’s not really one disorder, but rather a collection of different disorders with some shared features.  The diagnosis and optimal treatment remain elusive. The IBCC chapter is located 👉 here. The podcast & comments are below. Follow us on iTunes  

PulmCrit- RCTs don’t justify using convalescent plasma or antibody cocktails

January 14, 2021 by Josh Farkas 2 Comments

Passive immunity refers to the infusion of antibodies (either polyclonal antibodies in the form of convalescent plasma, or engineered monoclonal antibodies).  The goal is to neutralize viral particles, reduce viral replication, and thereby improve clinical outcomes.  This is a promising theory, but it requires evidentiary support in the form of randomized controlled trials.  So far, […]

PulmCrit – Six RCTs to answer one question: what is the role of tocilizumab in COVID-19?

January 12, 2021 by Josh Farkas 7 Comments

The REMAP-CAP trial recently detected mortality benefit from tocilizumab in patients with COVID-19.  However, several other RCTs have failed to find substantial benefit from tocilizumab.  This begs the question:  Has REMAP-CAP discovered a uniquely beneficial way to use tocilizumab, or is this simply a statistical outlier?   evidence roundup:  RCTs on tocilizumab Let’s review the trials.  […]

IBCC – Purpura Fulminans

January 4, 2021 by Josh Farkas 5 Comments

Purpura fulminans is a rare form of disseminated intravascular coagulation which requires specific management.  Most commonly it is seen as a complication of septic shock with multi-organ failure.  Unfortunately, purpura fulminans is often treated simply with a generic approach for septic shock. The IBCC chapter is located 👉 here. The podcast & comments are below. […]

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