Viren Kaul, MD Profile picture
Oct 17, 2021 5 tweets 5 min read Read on X
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
Saamia Hossain, MD: Impact of COVID-19 Pandemic On
Trainee Procedural Competency in the ICU -->

"Number of procedures completed did not
fully correlate with perceived competency."

#MedEd #COVID19 #CHEST2021 Image
Sofiya Rehman, MD:
* Bronchiolitis is frequently misdiagnosed as asthma before a definitive pathologic diagnosis is made.

This is huge, and we see this all the time, great work!!

#CHEST2021 #CHESTILD Image

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More from @virenkaul

Oct 20, 2021
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
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 20 tweets
Oct 20, 2021
Attending "Approach to Management of Pulmonary Infections in Immunocompromised Patients", LIVE right now on the #CHEST2021 platform, a thread🧵
. @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
.@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
Read 13 tweets
Oct 18, 2021
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
Oct 17, 2021
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
Read 6 tweets
Oct 17, 2021
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
Apr 2, 2020
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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