🔥🔥🔥Hot off the press in @ATSBlueEditor - new ARDS guidelines🔥🔥🔥

What we addressed:

💊 Corticosteroids
🔃 VV-ECMO
💉 Neuromuscular blockade
🐥 PEEP +/- recruitment maneuvers

👀 Read on for the recs & how to best apply them to your patients 🧵

atsjournals.org/doi/abs/10.116… What prompted this:

Previous guidelines were published in 2017. A lot has happened since then in ARDS-land, including the publication of several landmark as well as that whole #COVID19 thing. Thus, an update was in order.

Why do I hate hearing “the patient was bucking the vent”?

Mainly because it’s usually followed by “so we increased sedation.”

✅ Read on to learn what to say & do instead to better help your patient 🧵

#MedTwitter #NurseTwitter #MedEd

https://twitter.com/NidaQadirMD/status/1622264076322893824

What do people mean when they say this? Usually that the patient is on a vent & looks uncomfortable. Common but non-specific.

➡️ What I hear: the patient is on a vent & looks uncomfortable AND I’m not sure why

➡️ What I think of: buck teeth and/or a horse doing this

So this has been making the rounds. I realize it’s probably meant to be a thought experiment & deliberately provocative, but still, philosophical arguments should be rooted in at least some amount of reality.

I will now rage tweet about everything wrong w/ this concept. Enjoy🧵 Let’s start w/ the author’s premise: if we’re ok w/ #organdonation after brain death, then we should be ok w/ “whole body gestational donation” (WBGD).

Even putting aside the part about this sounding like a horrifying, dystopian baby farm, they’re not even remotely comparable.

Very excited to share our most recent publication about #CovidVaccine effectiveness, just published today by the IVY network. Especially relevant in light of today’s news about #boosters (spoiler - I’m skeptical about the need for boosters for all). 🧵

cdc.gov/mmwr/volumes/7… ➡️We looked specifically at vaccine effectiveness for preventing #COVID19 hospitalizations.

➡️We did NOT look at asymptomatic infections, or infections that did not result in hospitalization.

➡️Fully vaccinated = received 2nd dose of vaccine > 14 days prior to hospitalization

Most young women I’ve admitted to the #ICU for #COVID19 have been #pregnant. Pregnancy is indeed a risk factor for more severe COVID illness, but the messaging about #pregnancy, COVID & #vaccines has led to a lot of confusion and preventable illness. Let’s break it down. 🤰🏽🧵 The reason I pretty much always hear from pregnant women for not getting vaccinated is, understandably, not wanting to put their pregnancy & their baby at any potential risk from taking a new & seemingly unfamiliar vaccine.

Thanks @CNN for sharing this story on @UCLAHealth's collaboration with @LAOpera! In this program, opera performers lead #COVID19 survivors through breathing and singing workshops - it's an innovative (and fun!) adjunct to pulmonary rehab.

cnn.com/2021/07/18/us/… What does #opera have to do with pulmonary rehab? Well, would it be surprising to know that some of the work we do in pulmonary rehab is quite similar to the #breathing exercises opera singers do? The opera stars just happen to be doing them on an elite level.

Important questions about the type of ethical decision-making that needs to happen when resources become scarce - a situation no one wants to be in, but I worry may again become inevitable as #COVID19 cases continue to rise.

https://twitter.com/weselymd/status/1417098498974142468

Should #vaccinated patients be prioritized over unvaccinated, all else being equal? I don’t think so, no matter how frustrating this is. Many unvaccinated are victims of misinformation. Also, if we did this, then where else do we draw lines related to personal health behaviors?

Honored to present at combined medicine & surgery grand rounds @UCLAHealth today & a privilege to highlight the incredible work done by the UCLA #COVID19 front line. Also packed in a review of the evidence basis for COVID therapeutics & discussed COVID recovery. A lot to cover, and admittedly, I haven’t been that nervous about a presentation in a long time. I’ll share some slides here, starting with a summary of #COVID19 therapeutics.

Still getting the hang of Twitter chatting but...
A2 - start with brushing off your journal club #skillz! There are so many points to make here in terms of identifying confounders and bias, but I'll start w/ one I get asked about a lot - immortal time bias! #ATSChat

https://twitter.com/atsearlycareer/status/1334184302158901251

A2 - Immortal time = period of time during which, due to study design, the study outcome cannot occur. Occurs when there’s a difference between the timing of entrance into the study cohort & timing of the exposure. Exposure = the treatment being assessed. #ATSChat (2)

Just published in @bmj_latest, an update to our @WHO living guideline on drugs for #COVID19 – this update focuses on #remdesivir & was informed by the results of 4 trials w/7,333 participants – ACTT-1, SOLIDARITY, Spinner (JAMA), & Wang (Lancet). tinyurl.com/y4svlcyn Summary: based on currently available data, there is insufficient evidence that #remdesivir improves patient-important outcomes ➡️ thus, a conditional (weak) recommendation against the use of remdesivir in hospitalized patients with #COVID19.

#CCCF2020 Brian Kavanaugh Controversies - #COVID19: #ARDS or not? What we really addressed - not so much "is it ARDS?" but rather, "does it matter?" So happy to have been a part of this, but man, I still have so much to say! My take on the ? – yes, it matters - to an extent 🧵 1/ Pre-intubation management: YES, but not because it substantially changes methods of support, or the criteria used for #intubation. It matters because categorizing patients as having #ARDS has value. 2/

I don’t like posting depressing posts but I think it’s time. When this all began, I would walk into the #COVID unit with the energy of a #hype man at a #hiphop show. I hate COVID19 but I love being an #ICU doctor & getting people better. Today I am mentally & physically exhausted Other than my AM commute, I’ve seen daylight only once this week - today when I had a few minutes for a #coffee break. Today was also the first time I got home before 10 pm, but before I even had a chance to take my #decontamination shower...