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Jack Iwashyna Profile picture
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26 Dec, 4 tweets, 2 min read
#TeamNightShift @umichmedicine tonight

Stay safe, everybody

#COVIDsucks Image
Midnight teaching rounds led by @EmilyAHarlan (in chair, her back to me) of @MichiganPulmCC have interns + residents rapt

The time of night sucks. The need to learn + responsibility to teach are still there. I am proud of how our fellows consistently rise to meet the challenge Image
Love + respect to all you working tonight
I missed this coming in Image

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More from @iwashyna

Jack Iwashyna Profile picture
19 Aug
@MattWhite_95 @WesElyMD @DrDaleNeedham @SapnaKmd @tmprowell @HUMANIZALAUCI @A_MacLullich @Krockdoc @geri_doc @drdangayach @NidaQadirMD This is another one of those things harder to discuss over twitter than in-person
@MattWhite_95 @WesElyMD @DrDaleNeedham @SapnaKmd @tmprowell @HUMANIZALAUCI @A_MacLullich @Krockdoc @geri_doc @drdangayach @NidaQadirMD When we ask "is race associated with mortality?", we want to be clear what we are asking. Dr @RheaBoydMD has written about this better than I will, so I just refer you to her article

healthaffairs.org/do/10.1377/hbl…
@MattWhite_95 @WesElyMD @DrDaleNeedham @SapnaKmd @tmprowell @HUMANIZALAUCI @A_MacLullich @Krockdoc @geri_doc @drdangayach @NidaQadirMD @RheaBoydMD Bottomline: we rarely think the melanin content of the skin is directly leading to mortality. most of the time we really mean "is likely exposure to racism leading to mortality?"
Read 10 tweets
Jack Iwashyna Profile picture
5 May
#ICUreadings -- we're back!

Senior residents, so 2 articles per day at 2 pm

Effect of Pressure Support vs Unassisted Breathing Through a Tracheostomy Collar on Weaning Duration in Patients Requiring Prolonged Mechanical Ventilation via @JAMA_current

jamanetwork.com/journals/jama/…
#ICUreadings -- we're back! (2/2)

Effective Care Practices in Patients Receiving Prolonged Mechanical Ventilation. An Ethnographic Study via @ATSBlueEditor

ncbi.nlm.nih.gov/pubmed/32023081
Gotta love the clarity with which the Jubran paper describe the two methods of weaning, and of respiratory failure. I wish everybody was this clear

Trach collar was faster ImageImageImage
Read 16 tweets
Jack Iwashyna Profile picture
19 Apr
This proposed “do + report back” is literally the definition of research — changing care of a patient to create generalizable knowledge rather than focused on that specific patient—and is frankly unethical and probably illegal

#HardPass unless there is informed consent involved
Because this involves me being in a twitter fight with someone I deeply respect, let me be a little clearer
If the tweet were merely “optimize each of your patients’ care”, I would love it, and indeed I try to do that everyday
Read 11 tweets
Jack Iwashyna Profile picture
28 Mar
The initial logic behind using a single #ventilator to support #multiple #patients is compelling, and speaks to our most basic urge to rescue.

A long thread, to outline challenges that must be solved for it to work in #COVID19
There are certain situations in which it would work well – in patients with fundamentally normal lungs, whose compliance can be easily matched and kept matched, who can be deeply neuromuscularly paralyzed, and ...
for whom there is a plan for individualized ventilators to become available soon to make vent weaning/liberation possible.

(This is important: you can NOT wean multiple patients from a single ventilator, and there has to be a plan for eventual extubation)
Read 22 tweets
Jack Iwashyna Profile picture
17 Mar
#COVID19

We are now developing some experience w highly aerosolizing procedures on patients in full COVID19 PPE and negative pressure rooms

Quick thread
for every nurse in full PPE locked in with you inside during high risk #COVID19 procedures, have 1-2 outside to be runners and recorders.

Figure out how to safely transfer supplies in without having doors open or hand-to-hand transfers
The urge to hand things directly, rather than put them down to be picked up, is nearly overwhelming during stressful #COVID19 procedures

I think it is a form of solidarity

It is BAD for infection control
Read 6 tweets
Jack Iwashyna Profile picture
18 Feb 19
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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