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Last thought from my 1st day as an ICU attending in #COVID19 era

This is utterly terrifying for our non-clinician family members—they are way more worried than I am

And I, at least, get massive tunnel vision on service + often lack the emotional reserves/skills to support them
I am not a good husband/father/son when I am on service. We know that and have found strategies to adapt and make up for it

With increased #COVID19 service loads AND way more fear about my safety per service day, this is going to be really hard
I can’t really imagine what it like for nurses’ + RT’s families — but I want to thank them

#COVID19
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#COVID19

More from @iwashyna see all

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Jack Iwashyna
@iwashyna
Today 9:45 a.m. room 33 @SCCM #ccc48

"Bringing Meaning & Life Back to Survivors of Critical Illness"

I'm looking forward to a great session with @ICU_Recovery + @JulieRoganCNS

Here are my slides to give you a sense of what the conversation may be about. Join us!
Mark Mikkelsen and I have been deeply influenced by Creditor's classic article
ncbi.nlm.nih.gov/pubmed/8417639

These graphics hopefully forthcoming from Oxford Textbook of Medicine edited by @icuresearch

@SCCM #ccc48
Recovery-focus means thinking about preventing long-term harm, but also realizing critical illness is bad and some damage will occur given the limitations of our science and art

We need to help patients + families rehab but also ADAPT

@SCCM #ccc48
Read 9 tweets
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Jack Iwashyna
@iwashyna
#ICUreadings

Starting in the unit for 14 days tomorrow. The fellows + I are going to try to do 1 new paper a day to catch up, just a conversation with more senior trainees + attendings, with space for lots of assumed knowledge

Here's our prelim list if you want to read along...
#ICUreadings

Extracorporeal Membrane Oxygenation for Severe Acute Respiratory Distress Syndrome and Posterior Probability of Mortality Benefit in a Post Hoc Bayesian Analysis of a Randomized Clinical Trial
jamanetwork.com/journals/jama/…
#ICUreadings

Time for Clinicians to Embrace Their Inner Bayesian? Reanalysis of Results of a Clinical Trial of Extracorporeal Membrane Oxygenation
jamanetwork.com/journals/jama/…

Immune Checkpoint Inhibitor Toxicity in 2018
jamanetwork.com/journals/jama/…
Read 12 tweets
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Jack Iwashyna
@iwashyna
#BigData #ICU #sepsis research I wish some1 would do

Optimal Duration of Time-Limited Trials in Critically Ill Patients

"If they are going to respond to this, we should see a response by ..."

What are median + 95th percentile for responses to common life-saving therapies?
I feel like we "know" this for lots of small things
- Lasix should make 'em pee within 20 minutes
- PEEP improves oxygenation in 20 minutes
- uroseptic shock should break within 24 hour
There are some scattered superb research projects:
- optimal durations of SBTs
- optimal time to neuroprognostication s/p anoxic injury
- Blood cultures will turn positive for MRSA w/i 48 hours if they are going to
Read 6 tweets

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Matteo Villa
@emmevilla
🦠🇮🇹 Molte persone si sono convinte che #Covid-19 uccida il 7% di chi si ammala.
Altre sostengono che in realtà muoiano in pochissimi, meno dell’influenza.

Com’è possibile?
E chi ha ragione?

Oggi vi parlo di un iceberg, che però forse è una piramide.
Nel corso di un’epidemia non sappiamo esattamente chi si sia infettato. Sì, qualcuno può presentare sintomi più evidenti. Ma molti altri, magari, no.
Come facciamo a sapere che abbiano #COVIDー19? Facciamo test!

I casi confermati dai test sono un sottoinsieme dei contagi totali.
(En passant, non è esattamente così. Va più come rappresentato da @RosaTron qualche giorno fa.
Il numero dei deceduti non si sovrappone in maniera perfetta a quello delle persone testate: ci sarà sempre qualcuno, contagiato, che muore senza aver fatto il tampone.)
Read 24 tweets
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COVID19
@V2019N
*New* @TheLancet : We suggest that patients w/ cardiac diseases, hypertension, or diabetes, who are treated with ACE2-increasing drugs, at higher risk for severe #COVIDー19 infection & therefore, should be monitored for ACE2-modulating medications, such as ACE inhibitors or ARBs
The most distinctive comorbidities of 32 non-survivors from a group of 52 ICU patients w/ #COVIDー19 were cerebrovascular diseases (22%) & diabetes (22%).
thelancet.com/journals/lanre…
Another study 173 had severe disease w/comorbidities of htn (23·7%), diabetes mellitus (16·2%), coronary heart diseases (5·8%), & cerebrovascular disease (2·3%). Third study of 140 patients who were admitted to hospital with COVID-19, 30% had hypertension & 12% had diabetes.
Read 3 tweets
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Ameya Kulkarni, MD
@ameykulkarnimd
Lots of talk about the expected surge in ICU and hosp beds with #COVID. I’ve been hearing about reducing elective case burden (great thread from @ajaykirtane about that). We should also be rethinking our hospital approach to conditions that will continue in the covid era 1/n
Most obvious is with #STEMI care. If your hospital doesn’t have an ED bypass protocol for stemis - probably a good time to develop one. Ours at @VHC_Hospital has 1 min pitstop in ed w ems txp to cath lab - less pt exposure time to ED and less burden on ED resources 2/n
Also with #STEMI care - No icu for stable pts w normal EF should be standard. For most of these pts ICU is not necc and creates unneeded exposure for pt and occupies much needed ICU beds. (I think @agtruesdell had a great thread on this a while back) 3/n
Read 11 tweets
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Laurel Chor
@laurelchor
As a Hong Konger, I continue to be baffled by the public response in Europe. Though most are concerned, many are still acting like it's nbd. HK was in the news because of #COVIDー19 a month ago. There are travel advisories against HK. Peopled abroad asked me about it. 1/
There are STILL only ~130 cases in Hong Kong. There are now 798 cases in the UK & ppl are still out & about as if nothing is wrong. When I was in Milan (at a time when there were 3,000 cases), I was shocked at the lack of concern, including from police & health workers. 2/
When I was in Milan, I didn't understand how relaxed people were, and I felt like I was the crazy one. I kept trying to convey my disbelief and the severity of the situation to my colleagues, and how worried it made me for Italy – and Europe. 3/
Read 16 tweets
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Moritz Kuhn
@kuhnmo
@christianbaye13 & me have been thinking about the big differences in mortality rates so far during the corona outbreak in Europe. The differences in case-fatality rates are humongous. Italy has one of 6% while countries like Norway, Denmark & Germany have rates still close to 0.
Of course the rates will likely converge somewhat over time as the virus spreads and there are many effects in this. Division bias may play a role, as does the time since the outbreak.
However, we thought maybe there is something to learn in this in order to help to organize our lives in a way to minimize the risks for us and we pose to others. We picked up a striking data difference that @AndreasShrugged pointed out.
Read 23 tweets
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Ali
@aliostad
I gathered some alarming information on the rise of #COVID in Iran in this thread. I can see that it has been read by many hence increases my responsibility on what I share now.
As I stated before:

- I am not a trained reporter or journalist
- I am not based in Iran
- Not affiliated with any poilitical group, for or against the government
- Most of my information comes from the internet with occasional conversations with people in Iran
Today I shall try to gather information which I will share in the thread below.
Read 40 tweets

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