Remdesivir is being promoted as an anti-viral agent for the treatment of COVID-19. The first randomized, blinded, placebo-controlled trial of remdesivir was just released (Wang et al.). But before we dig into this trial, a little background… Background: Animal studies on Remdesivir Remdesivir is an anti-viral agent with strong efficacy against COVID-19 both in vitro […]
Search Results for: COVID-19
PulmCrit Wee: Lung pathology of COVID-19: is AFOP in play?
We’re beginning to start to see some information about lung pathology due to COVID-19. But before jumping into that, a little background… background: lung pathology, DAD, and AFOP Lung pathology & treatment: the bigger picture In an ideal world, different insults to the lung would cause specific histologic patterns. These patterns would be related to […]
PulmCrit – Before/after study of short-course steroid in COVID-19
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, […]
EMCrit 269 – Rationing of Critical Care and Ventilators in COVID19 with Reub Strayer
You need a plan right now for the allocation of scarce resources
COVID19 – Awake Pronation – A guest write-up by David Gordon, MD
Awake Proning for COVID19
PulmCrit Wee: D-dimer cutoffs to predict thrombosis in COVID-19
It’s increasingly clear that critically ill patients with COVID-19 can develop a pro-thrombotic form of DIC which places them at a dramatically increased risk of thrombosis. Thrombotic events may include pulmonary micro-vascular thrombosis (reported in some autopsies) or macro-vascular thrombosis (e.g., deep vein thrombosis). To date, an evidentiary vacuum has left it highly controversial as […]
PulmCrit – High-dose anakinra for COVID-19: The anti-inflammatory trials begin
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 […]
PulmCrit Wee- Could the best mode of noninvasive support for COVID-19 be… CPAP ??
COVID-19 patients seem to behave in a somewhat unique fashion, compared to other patients with ARDS. This isn’t based on high-level data, but it seems to be a theme emerging from a variety of centers (including my experience with one patient). Some salient points are: Low driving pressures are seen among ventilated patients. Thus, it […]
PulmCrit Wee – Multicenter RCT evaluating ruxolitinib (a JAK inhibitor) for COVID-19
Janus kinases (JAKs) are named after Janus, the Greek god of beginnings, gates, transitions, and duality. They’re named after Janus because they contain a mirror-image structural element. However, given their role within the immune system as a multi-functional gateway for cytokine systems, the name seems apt. The cytokine storm induced by COVID-19 has received considerable […]
EMCrit Wee – Alternatives to Vent Splitting and the Safest Vent Splitting Methods in COVID19
Will be updated as new info comes in…
PulmCrit – Thrombosis update in COVID-19: Data from the Mount Sinai system in NYC
One of the most controversial issues regarding management of COVID-19 is the appropriate dosing of anticoagulation. It’s universally agreed upon that patients with COVID-19 should receive some dose of anticoagulation (at least prophylaxis), barring contraindications. However, the optimal dose is unclear. Numerous reports indicate that patients with COVID-19 have high rates of venous thromboembolic disease, […]
PulmCrit – Six RCTs to answer one question: what is the role of tocilizumab in COVID-19?
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. […]
PulmCrit – Is COVID-19 ARDS, pseudoARDS, L, or H? Physiology data from Boston
There has been considerable speculation in the literature regarding the physiology of intubated patients with COVID, but little actual data. A fresh study describing the physiology of intubated patients at Massachusetts General Hospital and Beth Israel offers to finally answer some questions. This is a retrospective case series involving 66 patients intubated during March 11-30. […]
Management of COVID-19 patients admitted to stepdown or ICU
CONTENTS Rapid Reference 🚀 Initial tests to guide management Chest CT findings Organ support Cardiovascular Respiratory Noninvasive respiratory support Invasive mechanical ventilation Infectious disease – antibiotics Renal Hematology Neurology Immunomodulation Steroid Tocilizumab Baricitinib Tofacitinib Things that don’t work Remdesivir Convalescent plasma Questions & Discussion References checklist for COVID admission to ICU/stepdown ✅ Review medication list […]
EMCrit Wee – A Theoretical Model of the Pathophysiology of COVID-19 with Farid Jalali (Not a Single Thing Verified–Pure Musings)
Today on the podcast, my guest lays out a theoretical framework for the pathophysiology of the lung effects of COVID-19.
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