Thread by @WesElyMD

1/ Mechanism: Lung + Brain Injury in #COVID19:
 
In the ICU w/ #COVID we are dealing w/ SEPSIS & ARDS…most of what goes wrong in the human body when it’s infected with SARS-CoV-2 virus is mediated by…

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2/ Injury from SARS-CoV-2 virus is mediated by how much swelling (inflammation) and blood flow abnormalities (clotting and bleeding) occur, it’s wise to review what we know about SEPSIS, ARDS, & the BRAIN.

3/ Lung pathology affect parallel disturbances in the brain (& liver) via endotoxin, TNF, hypoxemia, shock & coagulopathy, metabolic derangements, & medical therapy such as the mechanical ventilator itself & sedatives & analgesics.

4/ Fascinating: Did you know the brain responds to systemic infections & injury with an inflammatory response of its own that also includes the production of cytokines, cell infiltration, and tissue damage?

5/ Animal models show that brain inflammation & subsequent activation of CNS immune responses are accompanied by peripheral perturbations of systemic inflammation w/ large amounts of peripherally produced TNF-a, IL-1b, and IFN-g that cause more organ dysfunction.

6/ Lung injury in #COVID19 does not occur in isolation. Rather, the patients’ brain is being injured in the process. In turn, it’s producing its own signaling that likely influences the overall outcome of your patient.

7/ We are currently giving Remdesivir & Steroids to reduce virus & mitigate our body’s injurious response to #COVID. But we are ADDING harm when we cause delirium (see 3-6 above) by overzealous benzos & immobilization, & removal of pts’ loved ones through isolation. #A2Fbundle

8/fin
Let’s reduce these iatrogenic components of #LONGCOVID (which is really #PICS) via higher compliance with the ABCDEF #A2Fbundle. It will save lives & reduce #PICS, making for happier return to patients’ former lives with their loved ones. (survivor shown w permission)