Thread by @WesElyMD

Green Urine: #NEJM
 
....will be seen in #COVID – Why? Massive use of Propofol. While Green Urine is Benign, effects of prolonged over-sedation & immobilization ++ #DELIRIUM are not 😤 Wake them up & get out of bed. Start w/SAT…#A2Fbundle & #PICS

#medtwitter #nursetwitter

1/ re: SATs to avoid over-sedation in #COVID19 pts, Thx @phanton_icu for Protocol Blindness caution & @Nitkjain reminder “Easier said than done.” I’ve been pondering your comments all day & think them ripe for further conversation on #A2Fbundle

#medtwitter #pulmcc #nursetwitter

2/ Remember, protocols like #A2Fbundle are guides & not “1-shoe-fits-all pts.” Correct, we must deviate when needed. However, these 6 principles (ABCDEF) are derived from 35 NEJM, JAMA, Lancet papers +400 others & now >25,000 pts of data. Not chump change.
bit.ly/2JwVA4E

3/ #COVID pts are quantatively different in ARDS/shock, yes (eg, LONG illness), but NOT qualitatively different. We should NOT throw out these safety principles. No. We have to adjust but not abandon. Our COVID-D study of 2,100 pts will be out in Lancet RM in a few weeks.

4/ COVID-D absolutely upholds that more deviation from our tried & true approaches yields a heavy burden of suffering in our patients, including ⬆️ death. Stay tuned. Let’s all work together to learn. Now, another word on Protocol Blindness…

#criticalcare #sccm #thrive

5/ In my own practice. I have found “anecdote blindness” a MUCH bigger problem. This occurs when I act on a series of anecdotes to the detriment of my other pts by abandoning solid evidence of a better way. This happened in the MIDST of the ABC Study and it almost cost us...

6/ In our ABC Lancet study, nurses thought SAT/SBT protocol wasn’t working & wanted to abandon. Turned out despite their anecdotal opinions in APACHE=26 pts that halving benzos/propofol/fent saved lives. COVID-D suggest same thing ~15 years later.

bit.ly/38GWrIj

7/fin So what am I saying? Yes, our #COVID19 pts are suffering immensely & getting historically heavy doses of sedation coupled w evil amounts of isolation from family + #delirium. What to do? EVERY time the sun comes up, we must try rehumanization again via #A2Fbundle

#pandemic

@threadreaderapp unroll please

Here I meant @phantom_icu