Discover and read the best of Twitter Threads about #coviddeepthoughts

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Some more #COVIDDeepThoughts after post-ICU clinic this week. All of the patients we saw were #COVID19 survivors in their 40s-60s, previously relatively healthy, had been intubated in the #ICU, some for quite a while. 1st, the good news. All of them were home & many back at work.
We had done a lot of video visits beforehand, which made things go much more smoothly...because of the video visits, many patients had gotten medication adjustments and subspecialist referrals they needed before seeing us in person.
Observations: Everyone experienced delirium in the #ICU, even those w/o OVERT delirium...ppl w/ neg CAM-ICU, RASS 0, interacting seemingly appropriately. Important to ask about this...I took care of almost all of these pts myself in the ICU & wouldn’t have known if I didn’t ask.
Read 9 tweets
The past few days have included a lot of thoughtful debate/discussion about #COVID19 and #ARDS, some snark (of which I too am guilty), and a hefty dose of HOW DARE YOU CHALLENGE A MASTER, YOUR RIGIDITY IS KILLING PEOPLE. I have a few things to say. Bear with me as I ramble a bit.
The idea that #EvidenceBasedMedicine does not allow for individualization for specific patients and changes in their clinical courses is a fallacy. Certain concepts that are known to save lives can & should be adhered to in a manner that is appropriate for the individual patient.
I thought this was obvious but that clearly is not everyone’s interpretation of #EBM. Also lung-protective ventilation does not = set it and forget it. Settings needed to maintain LPV will obviously change during a patient's course, something that experienced clinicians know.
Read 13 tweets
Some #COVIDDeepThoughts / reflections on clinical care in the #COVID #ICU now that I’ve had a chance to slow down a bit. It seems like a lot of folks are reaching for explanations for why #COVID19-related respiratory failure is something different & exotic & somehow not #ARDS.
As a result, a lot of pretty out there treatments with significant risks and downsides associated with them are being suggested by physicians, many of whom did not regularly care for #ARDS patients pre-#COVID19. These are being hyped up in the press & families are asking for them
I get it, it’s a lot less exciting to say “the patient recovered from #COVID19 w/ meticulous supportive #ARDS care” than it is to say “I did this weird new thing or gave this specific drug & the patient miraculously got better.” But #fundamentals >>> hype & unproven therapies
Read 8 tweets

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