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San Raffaele Anesthesia and Intensive Care Profile picture
@SRAnesthesiaICU
Apr 18 • 5 tweets • 4 min read Twitter logo Read on Twitter
🚫 DON’T use glucocorticoids in oxygen-free #COVID19 pts

Just published @NEJMEvidence
 
Guidelines are against glucocorticoids in pts not on O2 but effect on survival remains unclear
 
Our meta-analysis found that glucocorticoids increase mortality

🔗eviden.cc/3MnrDSA 1/5 Image
2/
📝 STUDY SELECTION
 
P: adults with #COVID19 not receiving oxygen
I: intravenous or oral #glucocorticoids
C: any
O: all-cause mortality at the longest follow-up available
S: RCTs, matched studies
 
➡️ 5 RCTs and 1 propensity-matched study (total 6634 pts) were included Image
3/
🪦 MORTALITY: #Glucocorticoids vs comparator

14% vs 10% (OR=1.56; 95% CI=1.27 to 1.93)
Number needed to harm=27
 
Mortality increase was confirmed in RCTs only
16% vs 13% (OR=1.34; 95% CI=1.00 to 1.78)
 
Need for mechanical ventilation was also increased: 18% vs 15%

#FOAMcc Image
4/
💡 IMPLICATIONS

#Glucocorticoids are a two-edged sword in COVID-19 treatment 🗡️ 
 
👍 Life-saving for patients receiving #oxygen

☠️ Harmful for patients not on oxygen
5/
SUMMARY

▶️ Our meta-analysis showed that #glucocorticoids increase mortality in #COVID19 hospitalized patients not on #oxygen.
 
▶️ Glucocorticoids should be used according to the oxygen status of COVID-19.

👇 👇 👇

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More from @SRAnesthesiaICU

San Raffaele Anesthesia and Intensive Care Profile picture
Apr 17
Our @MarinaPieri4 now presenting at @EACTAIC webinar: native heart recovery is the first choice option! ImageImageImageImage
2 RCTs are running on #levosimendan in VE #ECMO weaning @EACTAIC

Dieter Dauwe Image
In a patient with #ECPELLA #ECMELLA

Which device do you wean first?
#ECMO or #IMPELLA

Dieter Dauwe @DauweDieter
@EACTAIC @MarinaPieri4 Image
Read 7 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Jun 18, 2021
Inoperable patients can now be offered a potentially curative surgery.

🔗 Read @annalsthorsurg: pubmed.ncbi.nlm.nih.gov/34111383/ and the thread 👇 #FOAMcc #FOAMecmo
2/
Here we report the 1st case of intraoperative use of VA-#ECMO in a patient with resectable lung cancer and bivasal critical coronary artery disease with prohibitive low EF (23%), and describe the benefits of this new indication.

🔗 pubmed.ncbi.nlm.nih.gov/34111383/ #FOAMcc #FOAMecmo
3/
Cardiovascular comorbidities often prevent patients with otherwise resectable early-stage lung cancer from undergoing surgery due to prohibitive peri-operative risk.
Read 8 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Jan 21, 2021
1/

In non-COVID-19 pneumonia/ARDS filling defects are found in pulmonary arteries branches vascularizing healthy lung segments. Instead, in #COVID19 there is an almost perfect topographical overlap of filling defects distribution & pneumonia extent.

🔗 jcvaonline.com/article/S1053-…
2/
We demonstrated that pulmonary vascular thrombosis in #COVID19 is due to local inflammatory endothelial damage with a superimposed thrombotic late complication and not to recurrent thromboembolism from peripheral deep vein thrombosis.

#MicroCLOTS
3/
51% of pts showed pulmonary vascular thrombosis, with a median time from symptoms of 18 days.

We identified a specific radiological pattern of #COVID19 pneumonia with a unique spatial distribution of pulmonary vascular thrombosis overlapping areas of ground-glass opacities.
Read 7 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Aug 3, 2020
How we’ll we manage the first ten #COVID19 patients of 2021 (if any) hospitalized for #ARDS (compared to the first 10 patients we managed in February 2020). A multidisciplinary brain storming after managing approx 1000 such patients within the end of Apr 2020. A thread 1/ #FOAMed Image
2/
 Not all our clinical impressions have already published evidence (but the majority was published), but our hospital #COVID19 mortality went close to zero in late April 2020 and we hope medical management accounts for at least part of these results.
3/
 More, early ECMO. We put a dozen ECMO. We feel we should have put more of them and we should have done it earlier (eg after a couple of days of invasive mechanical ventilation with no improvement). @annamarascandro
@mgcalabroMD @md_monaco @MarinaPieri4
hsr.it/news/2020/magg…
Read 11 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Apr 24, 2020
[THREAD]

We just published the largest, most detailed case series of mechanically ventilated #COVID19 patients with ARDS in a western country and with the longest follow-up.

Read our infographic & the article on @CCRJournal bit.ly/2SiXYgD

#COVIDFOAM #FOAMed #FOAMcc
2/7
 Mortality of ICU mechanically ventilated patients with #COVID19 ARDS is as high as 23% at the 20 days follow-up.

#COVIDFOAM #FOAMed #FOAMcc
3/7
 Acute kidney injury (75%) and secondary bacteremia (37%) are the most frequent complications of #COVID19 ARDS.

Also, pneumothorax, pneumomediastinum, and thromboembolic complications were relatively common.

#COVIDFOAM #FOAMed #FOAMcc
Read 7 tweets
San Raffaele Anesthesia and Intensive Care Profile picture
Mar 4, 2020
How to administer oxygen worldwide in March 2020 to minimize viral dispersion: Tricks and Tips. #COVID19 #Coronavirus #COVID19foam #FOAMed #FOAMcc Thread 1/6 ImageImageImage
When using nasal cannula or High Flow Nasal Cannula consider adding a simple disconnected face mask as a shield to prevent viral spreading. #COVID19 #Coronavirus #COVID19foam #FOAMed #FOAMcc Thread 2/6 Image
According to Hui et al. High Flow Nasal Cannula could have higher risk of aerosol dispersion in mannequin study. #COVID19 #Coronavirus #COVID19foam #FOAMed #FOAMcc Thread 3/6

pubmed.ncbi.nlm.nih.gov/25224111/ Image
Read 6 tweets

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