A zentensivist discussion of ventilator management
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 […]
EMCrit 270 – Airway Pressure Release Ventilation (APRV) Time-Controlled Adaptive Ventilation
A Primer on APRV – TCAV, perhaps the mode of choice for COVID19
IBCC chapter: Guide to APRV for COVID-19
COVID appears to cause a form of pseudoARDS (rather than true ARDS). This responds especially well to APRV, often avoiding many forms of iatrogenesis (e.g., proning, paralysis, myopathy, deep sedation, and delirium). Embracing APRV requires a zentensivist perspective on tidal volumes and minute ventilation (they will vary a bit! you won’t have total control of […]
COVID19 – Awake Pronation – A guest write-up by David Gordon, MD
Awake Proning for COVID19
EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients
as of 3 APR 2020
PulmCrit Theoretical Post – The COVID Severity Index (CSI 1.0)
Prognostication is tough. The challenge is often not that we have too little data, but rather that we have too much data. There are now about two dozen risk factors for poor outcomes with COVID-19. How are we supposed to integrate all these bits of information at the bedside? Which pieces of information are redundant […]
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
EMCrit Wee – Stop Kneejerk Intubation with the EMCrit Crew
not NC at 6lpm then tube
PulmCrit wee – Why the SCCM/AARC/ASA/APSF/AACN/CHEST joint statement on split ventilators is wrong.
The story began in early March. With COVID-19 bearing down upon us, it became clear that we could run out of ventilators. This sparked interest in the concept of splitting ventilators between several patients. Some articles and videos were circulated on twitter describing how this could be done. These mostly described splitting a ventilator set […]
EMCrit Wee – Alternatives to Vent Splitting and the Safest Vent Splitting Methods in COVID19
Will be updated as new info comes in…
COVID Airway Management Thoughts
additional COVID airway management thoughts
EMCrit – Critical Care for Non-Intensivists during COVID19 Pandemic
Crit Care during COVID19
PulmCrit- Is Lopinavir/Ritonavir down and out?
A lot has happened since the last post on Lopinavir/Ritonavir (it was only March 4, but it seems like a year ago). Here is a quick reminder of where we left off: Lopinavir/ritonavir (tradename KALETRA) is a combination of protease inhibitors used in HIV, which might also be effective in COVID-19. Prior studies on SARS […]
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 […]
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