PulmCrit – Splitting ventilators to provide titrated support to a large group of patients March 15, 2020 by Josh Farkas 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: ...

COVID-19: Lessons to Learn from Public Discourse Regarding Hydroxychloroquine The COVID-19 pandemic has affected all aspects of our lives, including the economy, healthcare and scientific research. In the race to find effective and safe treatment for coronavirus disease, there has been a significant increase in scientific communication. However, the quality of this communication remains questionable. Preprints are not  peer-reviewed even though they are being...

PulmCrit – Awake Proning for COVID-19 May 5, 2020 by Josh Farkas Recently, many on twitter have been engaged in a furious debate about how to ventilate patients with COVID-19.  Is it ARDS or not?  High PEEP or low PEEP?…  As an intensivist, these issues are near and dear to my heart.  However, the truth is that humble methods to keep patients off invasive ventilation altogether are probably more important.  One such technique is awake pronin...

ARTICLES|ONLINE FIRST Defining persistent Staphylococcus aureus bacteraemia: secondary analysis of a prospective cohort study Richard Kuehl, Laura Morata, Christian Boeing, et al Lancet Infect Dis Published:August 04, 2020 DOI:https://doi.org/10.1016/S1473-3099(20)30447-3 Summary 摘要 Background 背景 Staphylococcus aureus persistent bacteraemia is only vaguely defined and the effect of different durations of bacteraemia on mortality is not well establish...

HealthManagement, Volume 20 - Issue 6, 2020 Improved Patient Assessment with MR-proADM Prof. Carlo Tascini is Head of Infectious Diseases Clinic at Udine University Hospital. Prior to that, he was the Head of First Division of Infectious Diseases Unit at Cotugno Hospital. His field of interests include endocarditis, meningitis, sepsis, MDR bacterial infection and fungal infections. HealthManagement.org spoke to Prof. Tascini about the clinical benefits of MR-pr...

ICU Management & Practice, Volume 20 - Issue 2, 2020 Is COVID-19 the Black Swan? Nassim Taleb, in his book, "The Black Swan: The Impact of the Highly Improbable," describes the term Black Swan as a rare, unknown event, which with hindsight is rationalised. Taleb talks about the human tendency to always find simplistic explanations for unknown events, what he calls the Black Swan theory. Is COVID-19 a black swan? Introduction Physicians working with cr...

ARTICLES| VOLUME 396, ISSUE 10251, P603-611, AUGUST 29, 2020 Effects of a major deletion in the SARS-CoV-2 genome on the severity of infection and the inflammatory response: an observational cohort study Barnaby E Young, Siew-Wai Fong, Yi-Hao Chan, et al Lancet 2020; 396: 603-611 Summary 摘要 Background 背景 Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants with a 382-nucleotide deletion (∆382) in the open reading frame 8 (ORF8) regio...

COVID-19: Hydroxychloroquine With or Without Azithromycin Hydroxychloroquine and azithromycin have been used to treat COVID-19 patients, but there is very little evidence with respect to the safety and efficacy of this treatment strategy.  Hydroxychloroquine has antiviral effects, and combined with azithromycin, it was believed that it could decrease SARS-CoV-2 viral load (based on results from a small, nonrandomised study). Based on this evidence, some practit...

COVID-19-associated hyperinflammation and escalation of patient care: a retrospective longitudinal cohort study Jessica J Manson, Colin Crooks, Meena Naja, et al Lancet Rheumatol Published:August 21, 2020 DOI:https://doi.org/10.1016/S2665-9913(20)30275-7 Summary Background 背景 A subset of patients with severe COVID-19 develop a hyperinflammatory syndrome, which might contribute to morbidity and mortality. This study explores a specific phenotype of COVID-1...

Corticosteroids in COVID-19 ARDS: Evidence and Hope During the Pandemic Hallie C. Prescott, ToddW. Rice JAMA. Published online September 2, 2020. doi:10.1001/jama.2020.16747 Corticosteroids, such as hydrocortisone and dexamethasone, have anti-inflammatory, antifibrotic, and vasoconstrictive effects, which intensivists have been trying to leverage for decades to improve outcomes in patients with acute respiratory distress syndrome (ARDS) and septic shock. In the f...