Discover and read the best of Twitter Threads about #ards

Most recents (24)

in 1932 #oxygen was delivered subcutaneously!
with non-negligible success

#ARDS #ecmo
In 1933 #oxygen wad delivered through the peritoneal cavity and stomach
with non-negligible success

#ARDS #ecmo
In 1935 #oxygen was delivered intravenously
with non-negligible success

#ARDS #ecmo
Read 5 tweets
Carolyn Calfee Clinical and Biological phenotypes of ARDS
- what do they have in common?

ARDS : subgrouping since the begining
- sepsis vs. non sepsis
- hyper vs. hypoinflamm
- reactive vs uninflamed
#ventilation #ards #phenotypes #LIVES2022
Are clinical phenotypes biologically distinct?
looking at Trauma vs. Non trauma

ICAM-1 , SP-D, vWF, sTNFr-1 are different.
What about in "Direct" vs. "indirect"
or "Diffuse" vs "focal" -- sRAGE comes up again.
#ventilation #ARDS #LIVES2022
Read 13 tweets
Uppsala- Sweden
"Do we Need a biological definition of ARDS"

- Berlin definition has NO Diffuse alveolar damage .
- the Berlin defn does not capture well
Frohlich - different definitions specificity of 0.63, 0.42, 0.31 even!
#ventilation #ards #LIVES2022…
The BJA article by Frohlich.
Fibrosis only starts after 7 days
Thille article :…
In essence, different disease processes are happening to the lung at different times in the "ARDS"
Read 14 tweets
ARDS - new definition or phenotypes by @GicoBellani refreshing with Kigali definition of ARDS - useful not just low resource but during pandemic in supposedly high income settings and only draw back is no PEEp requirement #ards #ventilation #LIVES2022 @ESICM
@GicoBellani @ESICM Resolved versus confirmed ARDS
- prospectively applying Berlin definition did work but if ya wait 24 hrs and re-measure P/F ratio, you end up stratifying much better.
- Better separation of groups
#ventilation #LIVES2022
@GicoBellani @ESICM Whichever definition - american european consensus or Berlin or Kigali -- all goes back to Ashbaugh original paper in 1967…

Why are we so confused when it comes to ARDS definition ?

#ards #ventilation #LIVES2022 @ESICM
Read 12 tweets
@ESICM #LIVES2022 #ventilation
#ARDS #Steroids. This morning I covered "4 key questions on NIV" and "steroids". Here is a collection of those threads.
@DrLeoHeunks 2. Claude Guerin on COVID vs. Non-covid NIV.…
Read 10 tweets
Next: Derek Angus : motivation to "TEST" steroids in COVID-19 ARDS.
Doctors "love" giving steroids. How about we "test" it?
#ards #steroids @ESICM
@ESICM steroids : long list of side effects ( 2' bac infection, impair host response, impair viral clearance).
- which steroid, when, what dose, how long
- unclear if all COVID patients in hospital should receive Steroids.
#steroids #ards
@ESICM large RCTs 1. RECOVERY(UK) - not 20mg in DEXA-ARDS but 6mg. in the O2 receiving group, Dexa seems to be better. Ventilated patient - very strong signal too of dexamethasone being better.
#COVID19 #steroids #LIVES2022 @ESICM
Read 13 tweets
NEXT: Clinical question : ARDS and steroids-sensitive patterns by President-Elect @ElieAzoulay5
lots of questions: why? how ? phenotypes? timing? dose? are we missing "systemic vasculitis,etc" behind defn ARDS?
#steroids #ARDS @ESICM
@ElieAzoulay5 @ESICM Refreshing ARDS definition. Berlin definition needs further updates (more on this later). 🤓
Pathological : DAD : Diffuse Alveolar Damage" has many causes - most of them we wont discuss steroid use at all.
@ElieAzoulay5 @ESICM thus DAD pathological diagnosis is not helpful to ask clinical question of steroids.
Interesting finding in autopsy data in ARDS. #LIVES2022
Read 10 tweets
NEXT: Corticosteroids in Bacterial pneumonia? By @antoniotorres Barcelona Spain.
Starting with 30-day mortality of severe CAP is very high. Microbial etiology is Strep pneumoniae, Legionella, Staph aureus, Pseudomonas and Polymicrobial #LIVES2022
@AntonioTorres @ESICM anti-inflamm Rx :steroids / macrolides may reduce mortality. Rationale : local and systemic inflammatory responses are increased in CAP, thus "down-regularte" them. Delfi consensus : no recommendation for any CAP but for in icu CAP patients, recommended. #steroids #ards @ESICM
@AntonioTorres @ESICM Rx steroids 0.5mg/kg/12 hr methylpred for 5 days for CAP. However influenza patient -- steroids may increase mortality. What happen also with Macrolides and Steroids combination ? In study : no synergistic effect and no additional improvement. #steroids #cap #ventilation @ESICM
Read 9 tweets
NEXT session:: ARDS Ventilator Management. Domenico.
Case-based discussion. 29 F +++ BMI, PBW ~ 52kg. Dx :community acq pneumonia. pH 7.33, pO2 12 pCO2 3.8, Be - 8, on o2 reservoir mask. Legionella urinary Ag +. #LIVES2022
#ventilation #ARDS @ESICM What would you do next?
Intubated. This is the CT.
Choices : volume control with NMB , Pressure control with NMB, Assist mode ventilation, sport mode?
Read 17 tweets
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…
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.
Read 8 tweets

对于轻症美国医生不理,只让回家隔离,低于92 去看急诊才有可能被收治

搞评:本推集来自2020年1月至今对 #新冠肺炎 的认知,从下面的旧推集提取归纳 Image
维生素C 400毫克
维生素E 100国际单位
维生素D3 (75公斤成年人每天0.125ng 5000IU,3个月后能把普通人验血的5-25ng/ml含量提升至50以上,降低感染风险)

早晚用#氯西丁(#Chlorhexidine)口腔清洁液清洗口腔咽喉 Image



只能用Acetaminophen (零售名称Tylenol)

不要用Ibuprofen (零售名称 Advil or Mortron)!!德法很多年轻的需要ICU的病例都是因为用了Ibuprofen 退烧,会加重新冠病情!
Read 38 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.
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.
Read 6 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 🧵👇🏼


#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


#Insulin #pancreas #metabolism

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...


#FatTissue #Endocrinology #Hormones
Read 16 tweets
A metal ion orients SARS-CoV-2 mRNA to ensure accurate 2′-O methylation of its first nucleotide
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
Japan Registry of Clinical Trials jRCTs071210011 Image
The influence of #HLA genotype on the severity of #COVID19 infection
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.…
Structural basis of ribosomal #frameshifting during translation of the #SARSCoV2 #RNA #genome
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
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!

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.”
#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…
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"…
Read 32 tweets
Reducing #COVID19 #Airborne #Transmission Risks on #PublicTransportation Buses
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
#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
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
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
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
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:…
Infographic (clickable PDF) in English:
#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 Developmental and functional outcomes were important.
Read 44 tweets
Llegó colección de lo #Mejor2020 en #PedsICU &
@Dr_Hari_Krishna 🇬🇧@MiguelrrMD 🇪🇸 @sgdambrauskas 🇺🇾

Versión infográfico español:
Version inglés:

#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:…
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
Read 42 tweets

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