Thread by @gretchemaben

Get ready for some tweet-ucation coming your way from the Murray Kornfeld Memorial Founders Lecture - “Our Pneumonia Journey: The Lungs and Beyond” with Dr. Marcos Restrepo! #CHEST2020

Tip 1: Know your goals, find your niche, and live by your values.
Tip 2: Find a mentor, seek feedback, and follow advice.
#CHEST2020

The global burden of pneumonia is massive. #CHEST2020

1 in 3 patients hospitalized with CAP die within 1 year. #CHEST2020

Guidelines for HAP/VAP/HCAP suggest coverage of multiple organisms. #CHEST2020

The goal of Glimp was to examine the prevalence of adult patients hospitalized with CAP and their pathogens and antibiotics. #CHEST2020

They found that among all of the participating countries the prevalence of MRSA was 3% in all cultures obtained, but 8% among positive cultures. #CHEST2020

They found that among all of the participating countries the prevalence of Pseudomonas was 4% in all cultures obtained, but 11% among positive cultures. These numbers were 2% and 5.4% for drug-resistant Pseudomonas. #CHEST2020

This study found that the majority of patients that don't have these risk factors (trach, bronchiectasis, very severe COPD, vasopressor or vent support) do not grow Pseudomonas. #CHEST2020

This study found that there were more pathogens not covered by CAP therapy in immunocompromised patients. #CHEST2020

In this study they found that the prevalence of anaerobic pneumonia in patients with aspiration pneumonia was actually low and the majority had GNRs. #CHEST2020

In this study >90% patients who were treated for CAP per guidelines were treated correctly, but the guidelines were only followed 42% of the time. #CHEST2020

The impact of the Glimp approach has been seen in these three areas: local policy and patient care level, education of trainees, and clinical practice guidelines. #CHEST2020

Super relevant quote. #CHEST2020

Tip 3: Take initiative, be proactive and share with others.
Tip 4: Be self aware, pay attention to time, and manage your emotions.
#CHEST2020

Community acquired pneumonia is a systemic disease that starts in the lung, but affects multiple organs. #CHEST2020

Initially it was thought that pneumonia caused a systemic inflammatory response that affected the endothelium which may lead to cardiac issues. #CHEST2020

Their group had published several observational studies showing myocardial dysfunction were more common in patients with prior CV disease. #CHEST2020

A recent systematic review and meta-analysis showed 15-20% of patients are developing CV events secondary to CAP. #CHEST2020

They started with observations in the mouse model. They were injected with Pneumococcus and developed microlesions of bacteria, but after antibiotics they had inflammatory cells and fibrosis. #CHEST2020

They then gave Pneumococcus to baboons. They found that the baboons developed pneumonia that was clinically similar to what humans got before antibiotics, followed by bacteremia. They were then treated with Ampicillin. The animals had signs and symptoms of infection. #CHEST2020

On autopsy they found Pneumococcus in the heart of those who did not receive antibiotics, but it disappeared in those who received antibiotics. #CHEST2020

Tip 5: Prepare yourself, everything counts, and keep learning.
Tip 6: Remain disciplined, persevere to the end and fight with courage.
Tip 7: Surround yourself with smart people, remain humble and treat them with respect.
#CHEST2020

"Before anything else, preparation is the key to success." Alexander Graham Bell
#CHEST2020

They knew that they had to care for their providers in this COVID-19 pandemic so that they could continue to care for their patients. #CHEST2020

They developed an inpatient COVID-19 chain of command, and a surge plan.
#CHEST2020

They developed a convalescence multidisciplinary care program to care for patients who were recovering. #CHEST2020

Tip 8: Adapt to adversity, be resilient, and find opportunities.
Tip 9: Engage others, commit to the mission, and care for those in need.
Tip 10: Enjoy the journey, live with gratitude and with love.
#CHEST2020

Overview of Dr. Restrepo's 10 tips. #CHEST2020

Conclusions!

Thank you to Dr. Restrepo for this fantastic presentation! #CHEST2020