COVID will eventually lead to many improvements in our approach to critical illness. I’ve been hoping that one of these would be an improved understanding of venous thromboembolism (VTE) prophylaxis, but perhaps that was overly optimistic. We provide VTE prophylaxis to nearly every patient in the ICU. Consequently, even tiny changes in our VTE prophylaxis […]
Search Results for: COVID-19
PulmCrit – Eleven reasons the NEJM paper on remdesivir reveals nothing
Grein et al. just published a case series of patients with COVID-19 treated with remdesivir via a compassionate use program. I’ve been expecting this paper with cold dread for some time now. There are several reasons that this publication is a media show, rather than a serious scientific endeavor. #1. Lack of a control group […]
PulmCrit: Remdesivir 5-day vs. 10-day trial raises some red flags?
So, Gilead’s first RCT on remdesivir was just published, and it’s very interesting.1 Gilead’s, you say? Yep. The study was designed, monitored, analyzed, and written by Gilead: Before getting into the study, let’s take a moment and think about what Gilead’s first RCT could look like. Gilead knows more about remdesivir than anyone (they built […]
EMCrit – Ghali Grills 1 – When to Use APRV
The first of a recurring segment: Ghali Grills me on APRV
PulmCrit – Systemic racism of pulse oximetry: Even worse than we thought?
One and a half years ago, a landmark study by Sjoding et al. found that critically ill Black patients were more likely than White patients to have falsely reassuring pulse oximetry measurements (discussed here).1 Subsequently, six sizable studies have been published on this topic. Since this is of critical importance to acute care medicine, it’s […]
EMCrit RACC Lit Review for December 2022
All the resus/acute critical care literature goodness for December 2022
PulmCrit Wee: High-titer convalescent plasma fails again for hospitalized COVID patients
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 […]
Mold infections (aspergillosis, mucormycosis)
CONTENTS Invasive pulmonary aspergillosis: Rapid Reference – Overall approach to the diagnosis 🚀 Basics Epidemiology Presentation Investigations Galactomannan Beta-D-Glucan Sputum culture & fungal stain PCR Radiology Bronchoscopy Tissue diagnosis Treatment Other forms of aspergillus infection: Aspergillus tracheobronchitis Aspergilloma Chronic cavitary pulmonary aspergillosis Other mold infections: Invasive pulmonary mucormycosis Podcast Questions & discussion Pitfalls #1/3: some […]
PulmCrit – Defining ARDS & recruitability, with implications for COVID treatment
In the past few weeks, there has been considerable debate regarding whether or not early COVID respiratory failure is ARDS. This is a linguistic mess, but it has real implications for treatment. So, it’s worth trying to sort it out… definition(s) of ARDS When clinicians use the term “ARDS” they are referring to a variety […]
Thoracic Radiology – Consolidation
CONTENTS Definition of consolidation General causes of consolidation Anatomic distributions: Round consolidation Diffuse consolidation Acute diffuse consolidation Chronic diffuse consolidation Peripheral consolidation Density: Low-density consolidation High-density consolidation Consolidation-related signs: Bulging fissure sign Reversed halo sign (aka, Atoll sign) Perilobular pattern Questions & discussion general definition of consolidation Consolidation refers to airspace disease that is dense […]
PulmCrit – Splitting ventilators to provide titrated support to a large group of patients
COVID-19 might out-strip the number of mechanical ventilators available to us. This has led to interest in using a single ventilator to support multiple patients. This post will review the theory and evidence regarding this (with the admission that I don’t have experience with this). basic principles Bedrock principle: Patient-Ventilator Independence Normally, we adjust the […]
EMCrit 343 – CV-EMCrit: Who to Refer for VV ECMO – Patient Selection and When to Call for Help
Who and When to Refer for VV ECMO
EMCrit Special – Burnout with Liz Crowe
More on burnout with an expert…
Sickle Cell Acute Chest Syndrome
CONTENTS Rapid Reference 🚀 Background Pathophysiology Epidemiology Presentation & diagnosis Trigger of acute chest syndrome Symptoms Examination & POCUS Radiology Rapid progression & multi-organ failure Definition & differential diagnosis Management Non-transfusion related Aggressive oxygenation & monitoring Volume resuscitation Antibiotics Pain management Transfusion General considerations about transfusion Simple transfusion (top-up transfusion) Exchange transfusion Manual exchange transfusion […]
PulmCrit: Why the DAMASK trial is a futile diversion – The limitations of RCTs
When I saw the infographic for the DAMASK trial (below), it was immediately clear to me that the trial was inconclusive (not positive, not negative – inconclusive). According to this study, masks might be totally worthless. Or masks might reduce infection by ~40%. This is an inconclusive study. It yields no answer.
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