Thread by @gretchemaben

And now we have some tweet-ucation from the FINAL ROUND of "Pardon the Interruption" featuring Kristin Burkart (@KristinBurkart3), Gabe Bosslet (@gbosslet) and Ron Goldenberg! #CHEST2021 1/

First topic: What is the role for empiric AC in critically-ill COVID patients, and at what degree of AC? #CHEST2021 2/

@gbosslett says prophylactic anticoagulation should be given, but not therapeutic dose AC without a clear indication. #CHEST2021 3/

Ron says that a baby ASA should be used for everyone and that anyone with concern or an increasing D-dimer should be considered for full dose AC. Target anti-Xa of 0.3-0.5 (low end of therapeutic). #CHEST2021 4/

@kristinburkart3 sides with @gbosslett and argues for standard prophylactic dosing based on the 2021 NEJM publication. #CHEST2021 5/

Ron argues back that the risk of clot is too high in patients with significantly increasing D-dimers and that a little AC doesn't hurt. #CHEST2021 6/

@gbosslett says SHOW ME THE DATA, RON!!! #CHEST2021 7/

@kristinburkart3 brings up the increased risk of bleeding and that the risk outweighs the benefit if there is no diagnosed clot. #CHEST2021 8/

Next topic: Is targeted temperature management for out of hospital cardiac arrest dead, or not? #CHEST2021 9/

Ron says it's not dead at all! 33 degrees is better than 36. #CHEST2021 10/

@KristinBurkart3 agrees with Ron. She doesn't care what number you pick - they are all TTM. You still have to actively cool to get normothermia. #CHEST2021 11/

@gbosslet: 33 is DEAD. 36 MIGHT be alive. We will likely find that fever avoidance is where it's at. Outcomes we saw in early studies were probably because we've learned that we need to give people more time to declare themselves. He's FLABBERGASTED @ their views. #CHEST2021 12/

@KristinBurkart3 says TTM is better at getting people to actually focused on cooling/normothermia. #CHEST2021 13/

@gbosslet says we're ignoring data. #CHEST2021 14/

Ron asks why are OOH arrests so different than in-hospital where we cool people? #CHEST2021 15/

@gbosslet says to do normothermia, even if you need an arctic sun to do that, but you've gotta show him data to argue 33. #CHEST2021 16/

Next topic: What is the appropriate timing for initiation of renal replacement therapy in AKI? #CHEST2021 17/

@KristinBurkart3 says that we don't have data to argue this, but she still feels that RRT should be started early because we know that volume overload is BAD. Start when you see them accumulating a positive fluid balance. #CHEST2021 18/

@gbosslet says he isn't particularly interested in stepping on nephrology's toes. Data doesn't suggest early RRT helps in ALL COMERS.
#CHEST2021 He does NOT get a point for the "master of domain" Seinfeld reference because he had the audacity to ask for it. #CHEST2021 19/

Ron argues for early RRT to avoid volume overload. #CHEST2021 20/

@KristinBurkart3 argues that she only said RRT when they stop responding to the diuresis you try first. #CHEST2021 21/

What about in ECMO patients? Ron says he tries not to use the ECMO circuit for RRT and does a different line. #CHEST2021 22/

Next topic: Does full isolation for mechanically-ventilated COVID patients detract from outcomes and, if so, what should we do about it? #CHEST2021 23/

@gbosslet says it absolutely detracts from outcomes. Keeping families away from their loved ones is hurting patients, families, and providers, and we should never repeat this mistake. We need to provide the the info to make their own decisions and the PPE needed. #CHEST2021 24/

Ron says we see more kinked ETT tubes and fewer consultants going in rooms. BUT we saw no C diff because of the isolation. Safety comes first. #CHEST2021 25/

@KristinBurkart3 says she understood the isolation at the peak of the NYC surge, but not now. Nurses are not in the room as often. There are more adverse effects, both physically and socially, when we keep people out of the room. We are harming patients & family. #CHEST2021 26/

@gbosslet says make sure people are vaccinated, but let them come in. #CHEST2021 27/

@KristinBurkart3 says if isolation does improve nosocomial infections maybe all providers we need to gown up for all patients, rather than keeping family out. #CHEST2021 28/

NOOOOO - Twitter just lost about 25 more tweets in this thread, but I will re-watch on demand later and finish the thread! #CHEST2021