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Viren Kaul, MD Profile picture
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17 Oct, 6 tweets, 6 min read
Done with the talks for today at #CHEST2021 .. Now to the opening session. So nice to see leaders sharing gratitude and giving thanks. It’s the small things that matter! @CHESTPrez Image
.@CHESTPrez acknowledges massive amount of work performed diligently by the #COVID19 task force and the @accpchest staff who led this virtual pivot with aplomb.
#on a personal note I’m so proud of my friends @GallodeMoraesMD @drdangayach for the presidential citation

#CHEST2021
.@CHESTFoundation award winners honored and now @davidschulman has taken on the mantle of @CHESTPrez!!

#CHEST2021 Image
“@accpchest is more than just an organization for us .. now more than ever, CHEST is a personal society .. and that’s incredibly invaluable!”

Couldn’t agree more #CHEST2021
.@davidschulman @CHESTPrez describes his priorities for his presidency:

* Increasing accessibility to @accpchest
* Increasing member engagement
* Building up the @accpchest foundation further

#CHEST2021 Image
Thank you @ChrisCarrollMD and @zielinski_dr the program chairs for #CHEST2021 .. it’s taken blood, sweat and tears .. but congrats on a fantastic meeting! Image

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More from @virenkaul

Viren Kaul, MD Profile picture
20 Oct
Next up for me: Changing Landscape of Prone Positioning with @sqsimp @GallodeMoraesMD @md_ritwick and Dr. Bosch.

Follow this thread 🧵 for pearls from this session.

#CHEST2021 #CHESTtrainees Image
Abbreviations:
PP = Prone Positioning
APP = Awake Prone Positioning
ARDS = You know it!
ARF = Acute Resp Failre

So then, let's learn!

#CHEST2021
Dr. Bosch:
What is APP? Proning patients who are not mechanically ventilated (MV)

He's presenting a case, let me ask you in the meanwhile; Do you perform Awake Proning?
Read 10 tweets
Viren Kaul, MD Profile picture
20 Oct
Attending "Approach to Management of Pulmonary Infections in Immunocompromised Patients", LIVE right now on the #CHEST2021 platform, a thread🧵 Image
. @kriscrothers: Diagnostic evaluation in patients with HIV include (pic 1)
* Historical elements
* CD4 count
* Chest imaging pattern

Know you infectious and non-infectious processes that can happen with decreasing CD4 counts (see pic 2)

#CHEST2021 ImageImage
.@kriscrothers: Compares bacterial pneumonia vs. PCP vs. TB
* > 1 infectious process in 10-20% pts with HIV
* Targeted Rx is key

W/U:
* Expectorated/induced sputum
* Sputum AFB x 3 w/ NAAT in 1 sample
* Bronch: If sputum negative for TB or no sputum for PCP

#CHEST2021 ImageImage
Read 13 tweets
Viren Kaul, MD Profile picture
18 Oct
Live-tweeting #PardonTheInterruption with @davidschulman

1. Will Bender
2. Bennett Deboisblanc
3. Ronald Goldenberg

Some punches are being thrown already ..

Somehow we brought up national chocolate cupcake day, whut? :-p

#CHEST2021
Topic: Role of Remdesivir for COVID-19:
WB: No data to support, even @WHO doesn't support it.
BD: Cost for quality low. Mortality benefit from best MA shows mortality benefit.
RG: No way, we don't do that up north! Maybe there is dec LOS, hell no on mortality.
#CHEST2021
What if pt already on Remdesivir prior to coming to ICU:
WB & RG: We continue
BD: Why, why, why? You don't want to start it, but want to hold on to it?
#CHEST2021
Read 9 tweets
Viren Kaul, MD Profile picture
17 Oct
There's a lot to take in on the #CHEST2021 platform, but don't forget to check out the e-posters. I want to highlight a few that caught my attention!

Pic 1: Aerobic exercise improves #Asthma phenotype in severe asthma
Pic2: Positive correlation b/w ONSD and ICH volume #POCUS1st ImageImage
Silvestri & co:
** Remimazolam safe & effective to achieve moderate sedation for flex bronch
** Faster sedation onset & recovery vs. placebo w/ rescue vs. open-label midazolam
** Ready for discharge sooner

#CHESTIP #Bronchoscopy #CHEST2021 Image
.@sarangspatil1: Preop HFNC in patients undergoing cardiac surgery associated with reduction in postop pulmonary complications & risk of post-op infections.

Scan the QR code for more details.

#CHEST2021 Image
Read 5 tweets
Viren Kaul, MD Profile picture
17 Oct
Live at 1400 ET: chestmeeting2021.junolive.co/live/mainstage…

"Airway management in the era of severe pneumonia" with #CHESTairways experts from the Airway Domain Task Force.

Will live tweet this talk on this #CHEST2021 thread.

Speakers:
@Chaeface @KDoerschug @J_Mendelson_MD and yours truly! Image
Let's get started with WHY our session is important:
🔥 Appx. 10% emergent intubations may result in failed airway
🔥 It's not just anatomical challenges, but physiological ones that have to be considered, esp with severe pneumonia
🔥 Lessons from the pandemic

#CHEST2021
* Let's talk about the vicious cycle of injury that occurs in acute resp failure (pic 1)
* Clinical course of disease imp for decision to intubate (pic 2)
* Ideal timing related to worsening work of breathing (pic 3)

PMID: 32747391
PMID: 27626833

#CHEST2021 #CHESTairways ImageImageImage
Read 16 tweets
Viren Kaul, MD Profile picture
2 Apr 20
Spoke to three close friends today. Just checking in on them since they are working at hotspots.

Here are direct quotes from those very people working >16 hours a day battling #COVID19

“I am suffering panic attacks.”

Think about that
Let me share with you why
“Coworkers are falling sick left & right. Every night as I lie in bed away from my fiancé, I think about falling sick, getting intubated & dying”

“What will my parents do”

“I can’t get over the fear in my fathers voice. I tell him I have #PPE, fact is he knows, and I know too.”
“People keep saying we are the brave front line workers. We see videos of cheering from balconies. But deafening silence as we wait for testing to return 3 days later on our sick patient.

We ask, and the answer is the same, it’s ramping up. So is our risk. #COVID19
Read 11 tweets

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