PulmCrit (EMCrit)

COPD exacerbation is bread and butter critical care.  However, familiarity can breed concept.  Thus, it’s important to always approach patients labeled with “COPD exacerbation” with fresh eyes, because they can present with other pulmonary pathologies as well.  The primary challenge among these patients is usually utilizing noninvasive support devices to avoid intubation, whenever possible. The […]

One of the most notable controversies in COVID is when steroid might be beneficial.  Since steroid is widely available and inexpensive, this issue has escaped the attention of pharmaceutical companies.  Consequently, evidence surrounding this is extremely sparse.  Available evidence consists largely of retrospective studies which relate steroid administration to outcome.  Such studies are inherently flawed, […]

An emerging body of evidence relates lupus anticoagulant to COVID-19.  Both of these topics are enormously confusing on their own, so let’s try to ease into this…    background on lupus anticoagulant what is lupus anticoagulant? Lupus anticoagulant isn’t any single thing, but instead it refers to a variety of different antibodies which may behave […]

Background Where were we with the Lopinavir/Ritonavir story?  Let’s backtrack for a moment. Lopinavir/Ritonavir showed some efficacy against SARS, but as triple therapy in combination with ribavirin.  A while ago, some studies tested lopinavir/ritonavir alone against COVID-19 and this didn’t work.  Consequently, that was set aside for a while.  However, there were lingering questions about […]

Over the last several weeks, we have seen a flurry of studies on various anti-viral therapies (lopinavir-ritonavir, hydroxychloroquine, chloroquine, and remdesivir).  On the whole, these studies were consistently unimpressive.  Perhaps remdesivir works a bit, but overall these studies simplified management by allowing us to ignore several drugs.  I’m expecting the anti-inflammatory trials to be the […]