Discover and read the best of Twitter Threads about #ARDS

Most recents (24)

1/🧵 An exacerbating factor in #LongCOVID is the “Quality of Life (QOL) Gap”🧵👇

…when a person’s expectations about QOL are at odds w their reality.
 
“Covid was over & Long COVID hit my brain, heart & GI.”
 
Let me unpack a study of ICU survivors…
bit.ly/3vp0AMl Image
2/ Read the thread I attached to the first tweet.

From the cancer literature, we learned about the QOL Gap.

If people appropriately prepare for their “ACTUAL” QOL, there’s a narrow gap and all is well.

If not, #Depression & #Despair too often set in.
3/ This study from Johns Hopkins by @vitaincerta & team adds to our understanding in a way that will apply so well to #COVID ICU survivors.

These are ARDS patients, which is almost always what lands COVID pts in the ICU and later with #PICS.
 
@CHESTCritCare Image
Read 8 tweets
1/🧵 Brain + Body damage in #COVID & Critical Illness
 
Sepsis -bacterial, viral, fungal- can cause rapid-onset #dementia. Finishing this test should be easy at her age but Millions of brain cells are damaged!

Protect yourself & others: #Vaxx + #Mask

H/T @trishla_17 for helping
2/ Our brain depends on a delicate balance of blood flow, nutrients & oxygen. When someone gets critically ill w #Covid or from other causes, that balance is dramatically disrupted. Small blood clots, dropping oxygen levels cause 🧠 damage.

bit.ly/36K5F65
3/ It’s odd to me that people don’t see severe COVID as a form of VIRAL SEPSIS. Sepsis is when infection of any kind causes your organs to begin to fail – lungs, brain, heart, kidneys.  It’s EXACTLY what we see day-in day-out in the COVID ICU.
 
bit.ly/3eM8pUx
Read 6 tweets
In the endothelium,selective impairment of insulin-mediated NO production may contribute to the development of #hypertension, endothelial dysfunction, atherogenesis, insulin resistance. NO induces vasodilation and inhibits platelet aggregation, vascular smooth muscle cell growth
Angiotensin #Ang2 inhibits insulin-mediated PI3K pathway activation, thereby impairing endothelial NO production and Glut-4 translocation in insulin-sensitive tissues, which results in vascular and systemic insulin resistance, respectively.
On the other hand, Ang II enhances insulin-mediated activation of the mitogen-activated protein kinase (#MAPK) pathway, which leads to vasoconstriction and pathologic vascular cellular growth.
Read 14 tweets
#POCUS y #SoMe4MV en #PedsICU
🔊en Ventilación Mecánica 🫁

Abro hilo, iniciamos, y abiertos los comentarios:
Esta información tuvimos el gusto de compartirla en el IV Curso Internacional de Medicina Intensiva Pediátrica dentro del XVI Congreso Internacional de Medicina Intensiva organizado por la @sopemi_org.
Gracias por la invitación. Ahora si, entremos en materia.
Los objetivos planteados en tres puntos:
Relacionar el Ultrasonido Pulmonar (LUS) y la Ventilación Mecánica (VM).
Conocer guías y monitoreo que nos ofrece el POCUS en VM y mencionar elementos evaluables por LUS.
Read 56 tweets
Demystifying APRV-TCAV yesterday at #TCAV course. Thank you for the invite @ThinkingCC #FOAMed #ventilation #COVID19 #ARDS
Initial settings - important to distinguish between rescue and post op atalectasis.

Set :
P high to 2mmHg less than patient's peak pressure on current settings.

P low to 0mmHg.
To set your resp rate:

60/current resp rate is your Time at high pressure (T high) + Time at low pressure (T low)

Eg: Resp rate of 25
60/25 = Thigh + Tlo = 2.4 secs
Read 11 tweets
Niveles elevados de glucosa en sangre (hiperglucemia) en pacientes con #COVID19

Abro 🧵👇🏼

1/15

#SARSCoV2 #Diabetes #Glucose
Primero algunos (4) conceptos:

1️⃣ Insulina

Es una pequeña proteína producida por el páncreas. Le indica a nuestras células que deben absorber la glucosa que les llega a través del torrente sanguíneo

2/15

#Insulin #pancreas #metabolism
2️⃣Adiponectina

La adiponectina es una hormona producida por las células que almacenan la grasa (adipocitos), tiene dos funciones principales: hacer que las células sean más sensibles ante la insulina, y...

3/15

#FatTissue #Endocrinology #Hormones
Read 16 tweets
A metal ion orients SARS-CoV-2 mRNA to ensure accurate 2′-O methylation of its first nucleotide
» doi.org/10.1038/s41467…
The #SARSCoV2 #coronavirus is able to utilize the changes in metal ion concentrations to disguise itself in the human host body thus evading immune responses. Image
Efficacy of #clarithromycin on #COVID19 pneumonia without oxygen administration; protocol for multicenter, open-label, randomized-controlled, 3-armed parallel group comparison, exploratory trial #CAMECOVID
» doi.org/10.1101/2021.0…
Japan Registry of Clinical Trials jRCTs071210011 Image
The influence of #HLA genotype on the severity of #COVID19 infection
» doi.org/10.1111/tan.14…
A genetic link has been discovered explaining why some people catch #Covid but don't get sick. The gene is found three times as often in people who are #asymptomatic. Image
Read 199 tweets
🔝5 Concerns about #SARSCoV2 #Biology: A Call to Pause, Deliberate, and Revise Policy─This review is intended both as a basic resource and to initiate an open and critical dialog about SARS-CoV-2 biology for an independent and public call to action. jjcouey.medium.com/5-concerns-abo…
Structural basis of ribosomal #frameshifting during translation of the #SARSCoV2 #RNA #genome
» doi.org/10.1126/scienc…
A unique feature of the SARS-CoV-2 genome controls protein synthesis and presents an "Achilles heel" of the virus. Image
Brainstem neuropathology in two cases of #COVID19: #SARSCoV2 trafficking between #brain and #lung
» doi.org/10.1007/s00415…
Neuropathologic evidence strongly suggests that the pathophysiology of COVID-19 related respiratory failure includes a neurogenic component. Image
Read 213 tweets
1/ 🧵A picture is worth 1,000 words 👁 #COVID19:

This 🎥 shows a clear example of what can happen to a person’s body w #COVID. His wife asked me to show it on twitter & urges everyone to get #vaccinate

(w/ consent of pt & wife)

#MedTwitter #NurseTwitter #CriticalCare
2/ You’ll notice his eyes are swollen shut. (Written perm to show). This is not fluid. It’s AIR from inside his chest leaking out his lungs 🫁 through muscles & skin to his neck & into his face. He is AWAKE & communicating but had ICU #delirium earlier.

#MedStudentTwitter #Nurse
3/ Look at his chest CT. See the “L” lungs w #Covid pneumonia/#ARDS & also AIR leaking out under his skin. Now go back to 1st tweet & watch 🎥 again. This is called “barotrauma” & happens when the 🫁s get too stiff and pop. Difficult situation. We’re hoping he can heal!

#MedEd
Read 5 tweets
1/ Do data support pt trial off sedation for “SAT” when pt is comfortable on current dose? Yes
 
Shared w permission:
“Dr. Ely, yesterday our ICU #nurses went over #A2Fbundle in Epic for implementation. Do you recommend SAT at RASS Goal of RASS -1 to +1?
#medtwitter #criticalcare
2/ Excellent #Nurse added:

“We are currently not doing SAT (Spontaneous Awakening Trial) but keeping pt’s RASS -1 to +1.  Just want to make sure we are interpreting #A2Fbundle correctly.”
 
#TipsForNewDocs
#medstudenttwitter #COVID19 #pandemic
3/ my Answers:

Great questions. I don’t think +1 (anxiety) is ever a good goal but 0 to -1 is a 👍 default target RASS if we acknowledge there are times when sedation target should acceptably be set as deep as -3/-4 in bad #ARDS or -5 transiently when pt requires paralytics.
Read 8 tweets
One of the shifts in my social media since my mother passed away is to engage in ways that people who are human, results-oriented, genuine can interact.. while recognizing there will always be the folks here for optics. It's a reminder to spend my time, energy, care for results.
You'll find threads on how I learned strength from my late mother

Is what I relied on when she was in the ICU or when we were living in a war zone

That's in contrast to the fragile & "threat!" approach that was on display with the Amy Cooper incident

bet.com/news/national/…
Keeping in mind that Amy Cooper campaigned/fundraised for Obama

yet, when, from the looks of it the black man was not important enough or she may have felt no one would find out

she threatened a black man in a mechanism of white power: "vulnerability"

discourseblog.substack.com/p/amy-cooper-i…
Read 32 tweets
Reducing #COVID19 #Airborne #Transmission Risks on #PublicTransportation Buses
» doi.org/10.1101/2021.0…
Wearing of #facemasks reduced the overall particle count released into the bus by an average of 50%, the dispersion distance by several feet and #aerosol particles by 84.36%. Image
🔝#SARSCoV2 Infects Human Engineered Heart Tissues and Models COVID-19 Myocarditis
» doi.org/10.1016/j.jacb…
#COVID19 can kill heart muscle cells, interfere with contraction. Details of how #coronavirus infects #heart: models of tissue damage may help develop potential therapies. Image
High-content screening of coronavirus genes for innate immune suppression reveals enhanced potency of SARS-CoV-2 proteins
» doi.org/10.1101/2021.0…
196 protein products of seven coronaviruses: the genes encoded by #SARSCoV2 are generally more potent immune suppressors than others Image
Read 236 tweets
⚠️#Ocular #MRI Findings in Patients with Severe #COVID19: A Retrospective Multicenter Observational Study
» doi.org/10.1148/radiol…
All patients had nodules in the macular region, 8/9 (89%) had bilateral nodules, 2/9 (22%) had nodules outside the macular region. Screening needed. Image
⚠️🔝New-Onset #IgG #Autoantibodies in Hospitalized Patients with #COVID19
» doi.org/10.1101/2021.0…
An international team of researchers studying COVID-19 has made a startling and pivotal discovery: The virus appears to cause the body to make weapons to attack its own tissues. Image
⚠️🔝Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance
» academic.oup.com/eurheartj/adva…
Damage to the heart found in more than half of #COVID19 patients discharged from hospital who show raised levels of troponin. Image
Read 235 tweets
Here is the #PedsICU #BestOf2020 collection.
Jointly chosen by
@Dr_Hari_Krishna @sgdambrauskas and myself
Pubmed collection 40 articles: bit.ly/pedsicubestof2…
Infographic (clickable PDF) in English: bit.ly/bestof2020eng
Spanish: bit.ly/bestof2020esp
#PedsCICU #NeuroPICU
This will be a bilingual tweetorial in Spanish/English!
Infographics are available in both languages in Tweet #1

El hilo será en Español/Inglés. El resumen infográfico está disponible en los dos idiomas en el primer Tweet
1/What are the outcomes that matter to children, to families and to #researchers/clinicians? @ericka_fink et al & @PostPICU_PALISI investigators identified COS using a delphi process. @CritCareMed bit.ly/381cfq8. Developmental and functional outcomes were important.
Read 44 tweets
#Tweetorial
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾

Pubmed: bit.ly/pedsicubestof2…
Versión infográfico español: bit.ly/bestof2020esp
Version inglés: bit.ly/bestof2020eng

#SoMe4MV #neuroPICU #delirium #PedsCICU
English #BestOf2020
The #Bestof2020 #PedsICU pubmed collection will also be available in the FREE #PICCHub app (sponsored by @PICSociety) as the latest monthly #PICUJournalwatch collection:
Download links: Android: play.google.com/store/apps/det…
iOS: apps.apple.com/gb/app/picchub…
3/ La FUNCIÓN como nuevo paradigma
@ericka_fink et al POST #PedsICU investigators & @PALISInet hicieron consenso Delphi
Qué es lo importante como resultados al alta #PedsICU?

En @CritCareMed lo que encontraron con precioso infogràfico
bit.ly/381cfq8
#PedsICU #PICSp
Read 42 tweets
#Ogitorial No35: hypothetical 41F #COVID19 intubated after failing NIV trial (24h).
A ETT 25cm
B SpO2 82% FiO2 1 Vt350 P12
❤️BP 110/80 HR 95, CapRef 1.5”
D avpU (propofol)
E Obese, no rash, soft abdomen
U bil B lines, RV=LV, EF~60%,
L pH 7.29, PCO2 35, Cr 1.4, Lactate 2.2 Hb10
Patient got remdesivir & dexamethasone. SpO2 88% after bolus NMB & pulling ETT(3cm). As you increase PEEP to 18, driving pressure improves, but the SpO2 drops to 72% without hypotension. You decrease PEEP back to previous but SpO2 still 70s. The next step is: #FOAMcc #MedTwitter
1/ With inhaled NO SpO2 improved to 97%, and after 2h FiO2 was down to 40% and rapid weaning.
Bubble study confirms suspected intermittent #PFO shunt which occurs in up to 19% #ARDS with ⬆️rescue Rx & ⬇️VFD
pubmed.ncbi.nlm.nih.gov/20601861/
pubmed.ncbi.nlm.nih.gov/33252722/
pubmed.ncbi.nlm.nih.gov/33150525/
Read 4 tweets
Opening talk @WFPICCS is ‘protective lung ventilation’ by Robinder Khemani

Much data is from the adult ARDSNet work demonstrating 6ml/kg is optimal data for adults

#PedsICU #WFPICCS20
However - limited #PedsICU data for #pARDS and some data suggests higher tidal volumes in children may have better survival.

But this is not an RCT data...and some data shows higher driving pressure is associated with increased mortality...

#WFPICCS20
Should we be using transpulmonary pressure as a measurement rather than driving pressures in #pARDS?

In our unit we don’t measure transpulmonary pressures... but might be worth thinking about

#PedsICU #WFPICCS20 #PedsAnes
Read 8 tweets
Such a great experience working with this amazing group of co-authors examining the effect of NMBA in #ARDS ! ! In particular, @AlhazzaniW is one of the best mentors out there! This topic is of extremely high relevance with the COVID-19 pandemic. 1/
With the ROSE trial, there were legitimate questions raised re: utility of NMBA use in ARDS. ROSE, however, used a light sedation strategy which was different from the other studies. As expected, we found a subgroup difference in mortality when comparing according to sedation /2
As such, we could not pool the results of mortality all together as ROSE had a different population as part of their study /3
Read 9 tweets
Get your popcorn ready because this is going to be quite the learning contest. #CHEST2020

The webinar is LIVE in T - 5mins, speakers are checking their 🎤🎤

We are only a tiny bit biased towards our co-chair @GallodeMoraesMD!
Dr. Mathews: Starts with sharing what drives ventilation-induced lung injury. This is "leak" is likely more pronounced in #COVID19

#CHEST2020
Dr. Mathews: ARMA supported LTVV in ARDS with significantly improved mortality. LTVV has been since found to be beneficial in non ARDS situations. #CHEST2020
Read 26 tweets
First up for me, @mnarasimhan moderating the 2020 PETAL Update #CHEST2020 Image
Tune into this session at #CHEST2020 for updates on these #ARDS trials! Image
Dr. Adit Ginde presenting the VIOLET Trial of #VitaminD and #ARDS showing the Vitamin D did not improve outcomes in this population. #CHEST202 nejm.org/doi/10.1056/NE… Image
Read 12 tweets
#CCCF2020 Brian Kavanaugh Controversies - #COVID19: #ARDS or not? What we really addressed - not so much "is it ARDS?" but rather, "does it matter?" So happy to have been a part of this, but man, I still have so much to say! My take on the ? – yes, it matters - to an extent 🧵 1/ Image
Pre-intubation management: YES, but not because it substantially changes methods of support, or the criteria used for #intubation. It matters because categorizing patients as having #ARDS has value. 2/
If we use the Berlin definition, patients on Venturi masks or arguably #HFNC don’t actually meet criteria for #ARDS because they’re not on PEEP >/= 5. The natural history of ARDS though almost certainly begins prior to the use of mechanical ventilation (invasive or not). 3/
Read 13 tweets
1/ There are clinically relevant differences between #COVID19 #Sepsis & typical bacterial sepsis, but they are Quantitative rather than Qualitative. That is, all clinicians have seen them before in other sepsis pts before this #virus 🦠 infected its 1st human.

#medtwitter #meded
2/ Quantitative septic findings are more commonly part of daily care for #COVID patients than we have been used eg, near total loss of the tracheobronchial tree’s muco-ciliary escalator due to destruction of ciliated respiratory epithelium.

#pulmcc #tipsfornewdocs #criticalcare
3/ Classically in #Influenza pneumonia/sepsis, this predisposes to subsequent superinfection from bacteria like Staph & Strep. In #COVID, we are always on the ready to begin antibiotics to cover such complications of what initially was a pure viral infection.

#medstudenttwitter
Read 8 tweets
1/8 Corticosteroids and COVID19
*Three* RCTs and a new @WHO meta-analysis add to #RECOVERY trial data that corticosteroids reduce mortality in critically ill #COVID19 patients
jamanetwork.com/journals/jama/…
2/8 Corticosteroids & COVID19
i. Low-dose hydrocortisone didn't reduce death, persistent respiratory support at day 21 vs placebo among critically ill patients w #COVID19 and ARF, but the study was stopped early when RECOVERY trial findings were announced
ja.ma/31NqEDf
3/8 Corticosteroids and #COVID19
ii. IV #dexamethasone increased the number of ventilator-free days by day 28 vs standard care alone among patients with COVID19 and moderate or severe ARDS
ja.ma/3bjH2yt
@ICURevisited @FlaviaSepsis @israelmaia16
Read 8 tweets
@Know_More_News A randomized placebo-controlled trial in children showed that #flushots increased fivefold the risk of acute respiratory infections caused by a group of noninfluenza viruses, including #coronaviruses. (Cowling et al, Clin Infect Dis 2012;54:1778)😂

bmj.com/content/368/bm…
@Know_More_News It is possible that #influenza vaccines alter our immune systems non-specifically to increase susceptibility to other infections; this has been observed with DTP and other vaccines. (Benn et al, Trends in Immunology, May 2013). #covidhoax #vaccines

bmj.com/content/368/bm…
@Know_More_News #influenza & #ARDS (#COVID19 trick 😉🤓)
"...consequences of severe respiratory failure and multiple organ dysfunction. Death is usually due to sepsis and #MODS (multi organ dysfunction).." pag 3 ncbi.nlm.nih.gov/pmc/articles/P…
Influenza has the same scenario as #COVID19
Read 5 tweets

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