Discover and read the best of Twitter Threads about #COVID19FOAM

@JenniferSpicer4

1/ Can antibody testing help predict true case fatality rate for #COVID19?

Thx @EmoryMedicine M3s Timothy Arleo & @mlmargol (creators), M4s @tylerdau &@cg_coleman (editors) & Emory ID fellow Aaron Kofman (review)

#EducationInTheTimeOfCOVID #COVID19FOAM

2/ This study has multiple limitations making it difficult to know the accuracy of the results.

It will be interesting to see the results after the peer review process.

3/ Here's a link to the pre-print (i.e. not peer-reviewed yet)
doi.org/10.1101/2020.0…

Link to our #EmoryID fellows' scholar blog w/ other lit summaries by our ID fellows; plus visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

Read 3 tweets

Jennifer Spicer, MD, MPH

@JenniferSpicer4

How well do alcohol-based hand rub formulations inactivate SARS-CoV-2?

Thx @EmoryMedicine students @emilyslovern & @sims_hershey (creators), @an_xiao_& @cg_coleman (editors) & @EmoryDeptofMed ID fellow @DanielSGraciaa (reviewer)

#EducationInTheTimeOfCOVID #COVID19FOAM #COVID19

A link to the article @CDC_EIDjournal by @AnnikaKratzel & @StephaniePfaen1
doi.org/10.3201/eid260…

Link to our #EmoryID fellows' scholar blog w/ other lit summaries by our ID fellows; plus visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

Please tag additional authors of this work!

Read 3 tweets

Jennifer Spicer, MD, MPH

@JenniferSpicer4

The ISTH recommends prophylactic anticoagulation for #COVID19 inpatients

Thx @EmoryMedicine students @andre_kerri & @justalisongrace (creators), @tylerdau @cg_coleman (editors) & @EmoryDeptofMed ID fellow @alfherrom (review)

#EducationInTheTimeOfCOVID #COVID19FOAM

Here's the link to the article
doi.org/10.1111/jth.14…

And the link to our #EmoryID fellows' scholar blog w/ other lit summaries by our ID fellows; plus visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

@RoyKhalife89 - would love to hear your thoughts on this!

Read 3 tweets

Jennifer Spicer, MD, MPH

@JenniferSpicer4

1/Recent article on remdesivir for #COVID19. More summaries to come soon on more recent data.

Thx @EmoryMedicine MS3s @an_xiao_ & @chung_yg (creators), MS4s @tylerdau & @cg_coleman (editors) & #ID fellow @Dr_AmyKacin (review)!

#EducationInTheTimeOfCOVID #COVID19FOAM

2/This is not a randomized controlled trial, which is the data that we really need. Trials ongoing with results soon.

3/Here's the link to this article in @NEJM
doi.org/10.1056/NEJMoa…

And the link to our #EmoryID fellows' scholar blog w/ other lit summaries, visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

Read 3 tweets

Jennifer Spicer, MD, MPH

@JenniferSpicer4

What was the impact of various public health interventions on #COVID19 in Wuhan, China?

Thx @EmoryMedicine M3s @SimonCohen617 & @blokolog9 (creators), @tylerdau & @cg_coleman (editors) & @EmoryDeptofMed #ID fellow JessH_A (review)!

#EducationInTheTimeOfCOVID #COVID19FOAM

Here's a link to the article in @JAMANetworkOpen
jamanetwork.com/journals/jama/…

And the link to our #EmoryID fellows' scholar blog w/ other lit summaries, visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

Here's the actual link - sorry, that prior link was to the commentary on the article:
jamanetwork.com/journals/jama/…

Read 3 tweets

San Raffaele Anesthesia and Intensive Care

@SRAnesthesiaICU

[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

Jennifer Spicer, MD, MPH

@JenniferSpicer4

1/This retrospective study did not show any benefit of hydroxychloroquine in patients w/ #COVID19

Thx @EmoryMedicine M3s @AGangavelli & @sverma46 (creators), @chung_yg & @cg_coleman(editors) & Emory ID fellow @Dr_AmyKacin (peer review)

#EducationInTheTimeOfCOVID #COVID19FOAM

2/We are still waiting results of the randomized controlled trials for definitive evidence, but this additional data continues to suggest that HCQ is not helpful for #COVID19

3/And here's a link to the pre-print (i.e. not peer-reviewed yet): doi.org/10.1101/2020.0……

And the link to our #EmoryID fellows' scholar blog w/ other lit summaries, visual abstracts & infographics created by our medical students. scholarblogs.emory.edu/covid19roundup/

Read 3 tweets

Dr. David Lyness

@Gas_Craic

Thank you to @ICNARC who have published data on the first 5578 critically ill patients in the NHS. I've summarised some of their publication in this thread below: #covid19 #covid19foam #foamed #FOAMcc Original here: icnarc.org/Our-Audit/Audi…

The data does not include Scottish ICUs - but does for Eng, Wales and NI. To date (yday) there have been 6664 ICU admissions due to COVID19. The largest cohort being in London. There is also cumulative data of numbers by date. #covid19 #covid19foam #foamed #FOAMcc

You can see the *current* distributions of cases across England, Wales and NI #covid19 #covid19foam #foamed #FOAMcc

Read 9 tweets

Segun Olusanya

@iceman_ex

Fascinating discussion from the @ICS_updates webinar

Differing opinions on HFNC, CPAP and intubation

The risk of P-SILI described by @bjoern_weiss

Versus the benefits of avoiding intubation

Again: NO ONE can predict who will successfully manage with noninvasive therapies.

Up to 50% of patients will manage with noninvasive therapies alone (CPAP/HFNC)

But which 50%? Does everyone warrant a trial? And where should this trial take place?

#icswebinar #covid19foam

The discussion around PEEP is ongoing

SuperPEEP is out. A modest level of PEEP (8-10) is suggested by @deoxyexplorer

Superdry for fluid balance is also out- euvolaemia is current target.

#icswebinar #covid19foam

Read 9 tweets

Salim R. Rezaie, MD

@srrezaie

#COVID19 PNA is ARDS...just not "typical" ARDS as @MiscSusan has so eloquently stated

#COVID19FOAM

Lung compliance can often be normal/high (L type) but can progress to low compliance (H type)

Berlin Criteria:

Timing: w/i 7d
Imaging: Bilateral infiltrates
Origin: Not explained by cardiac failure/fluid overload
Mild: P/F <200mmHg (≤300 with PEEP/CPAP ≥5cmH20)
Mod: P/F <100mmHg (≤200 with PEEP/CPAP ≥5cmH20)
Severe: P/F ≤100mmHg with PEEP ≥5cmH20

Read 3 tweets

Dr. David Lyness

@Gas_Craic

Welcome to the @esicm webinar on renal issues in #COVID19 including AKI & CRRT esicm-tv.org #COVID19foam #foamed #FOAMcc

Low rates of AKI and CRRT initially thought. Does this marry up with the current picture?

AKI and CRRT data in #COVID19 currently. Real world data. #foamed #foamcc

Read 13 tweets

Carolina Maciel

@neurologyrules

1/9
#COVID19FOAM
#StopTheSpread
#ProtectHealthCareWorkers

Joint effort from @American_Heart @ACEPNow @SOCCA_CritCare @AmerAcadPeds @aarc_tweets @ASALifeline guiding #resuscitation efforts in #cardiacarrest in suspected/confirmed #COVID19
bit.ly/3e8QplH
@CircAHA

2/9
General Principles of #ProtectHealthCareWorkers have always applied to first responders in prior #resuscitation guidelines. Remember, first things first:

👉Assess the safety of the scene, make sure that victim, yourself and bystanders are safe

#GetMePPE

3/9

Minimize the number of people in the room

👉 Whenever able, mechanical CPR devices can reduce the number of rescuers required & provide consistent high-quality compressions

Read 10 tweets

𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊

@PulmCrit

new section on the mixology of analgo-sedation for intubated COVID patients. there are lots of approaches analgo-sedation, this is my favorite mix...(1/6)
#COVID19foam
IBCC section: bit.ly/3aTDlyL

if possible, achieving an awake & comfortable patient on the ventilator is enormously beneficial:
- easier to extubate
- can communicate, determine sources of pain
- might help avoid lung-injurious tidal volumes
- less delirium, faster rehab (2/6)

the fundamental principle is multi-modal analgo-sedation. using *low* doses of *several* medications maximizes synergistic efficacy, while avoiding the toxicity of any specific agent (#3/6)

Read 6 tweets

josh farkas 💊

@PulmCrit

continuing to see crazy pro-coagulable states in COVID-19, for example patients breaking straight through therapeutic dosing of heparin 👇 (#1/3)
#COVID19foam

the role of anticoagulation remains largely unknown. here are my current thoughts on this, recognizing the complete absence of high-level evidence (#2/3).
(IBCC section: bit.ly/2x6EjZK)

please post any thoughts, comments, new evidence etc. at this page which was developed specifically to discuss COVID-DIC. (#3/3).
emcrit.org/squirt/covid-d…

Read 3 tweets

Salim R. Rezaie, MD

@srrezaie

Fascinating paper shared with me via @DFarcy Preliminary Observations on the Vent Management of ICU #COVID19

sfar.org/preliminary-ob…

COVID-19 ICU pts are NOT similar to ARDS pts. They have profound hypoxia with pulmonary compliance that is generally high

#COVID19FOAM

High-Pulmonary Compliance: Hypoxic vasoconstriction. Major issue is lung perfusion. Increasing PEEP and prone positioning are of minimal help with recruitment of collapsed lungs. In these patients high PEEP (>15cmH20) may compromise right cardiac filling

Oxygen Alone vs Ventilation: High FiO2 more important in the short run, other interventions (i.e. intubation) may be more harmful than buying time

Read 7 tweets

𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊

@PulmCrit

IBCC correction: Procalcitonin in COVID-19 😬. Initially the IBCC stated that COVID-19 didn't generally increase procalcitonin, based on several studies👇... but intubated COVID patients in my unit are routinely showing procalcitonin elevations in the range of 1-10 🤔 #MeaCulpa

if we dig deeper into the Guan study, we see that some patients with more severe disease *do* have procalcitonin elevation 👇. so procalcitonin elevation might be a reflection of more severe infection, vis a vis cytokine storm 🌩️.
(study: bit.ly/2vPTyWq)

🔎 recent meta-analysis of procalcitonin in COVID-19 also found this: elevated procalcitonin may be a marker of more severe disease. (although can't prove with 100% certainty that these patients don't have bacterial co-infection)
(article: bit.ly/2QLk8Y2)

Read 4 tweets

KateRnest

@TheRealNarcos

Echter Verlauf eines COVID-19 Falls
Frau Mitte Vierzig. Befindet sich seit So in unserer Klinik

Vorgeschichte
Seit Di vorletzter Woche fühlt sich Frau Xx sehr schlapp. Sie beschließt zum Arzt zu gehen Klagt über Fieber ,Kopfschmerzen und trockenen Husten.
#COVID19FOAM #COVID19

Die Hausärztin fragt nach Reisen in ein Coronarisikogebiet. Frau Xx verneint. Auch Kontakte zu Coronakranken habe sich nicht gehabt. Letztlich erhält Sie symptomlindernde Medikamente und wird wieder nach Hause geschickt.
#COVID19 #COVID19FOAM

In den folgenden Tagen kommt es zu vermehrten Husten und progredienter Dyspnoe. In der Zwischenzeit erkrankt auch der Ehemann, wenn auch nicht so schwer.
#COVID19de #covid19foam

Read 15 tweets

Internet Book of Critical Care

@iBookCC

Going thru the Surviving Sepsis Campaign guidelines on COVID. There's some good stuff here, if you can skip thru the usual SSC boiler-plate nonsense (lactate as a perfusion endpoint 🤣).
(guidelines: bit.ly/2QvTm5x)
#COVID19foam

Air quality:
- SSC rec's negative pressure rooms for aerosol-generating procedures. Sure, but we are rapidly running out of them.
- When negative pressure isn't available, HEPA filters should be used whenever possible (they asked: how many? GIVE ME ALL THE HEPA FILTERS).

Masks
- SSC rec's surgical masks for non-vented patients who aren't undergoing aerosol-generating procedures
- Try to conserve N95s for when they are absolutely needed
- Sensible advice if N95 supply limited (risk of burning through the supply of N95s on COVID rule-outs)

Read 18 tweets

Damian Caraballo MD

@813JAFERD

Thread on some ED Doc's thoughts on dealing with #COVID19US on frontlines

1/ First PPE: At this point, everyone should be wearing a surgical mask at your desk and in ED. No eating or drinking unless in Staff lounge, away from patient care

2/ When going into a potential #Covid19 room, wear a N-95 if you have it. Put a surgical (eg. regular) mask over it to protect it, then wear a face shield over that. Googles not as good, but we'll take what we can get.

Read 26 tweets

𝙟𝙤𝙨𝙝 𝙛𝙖𝙧𝙠𝙖𝙨 💊

@PulmCrit

I've been dreading this, but I think we need to reconsider the issue of steroid in COVID-19. This is extremely complicated, especially for two reasons...(1/7)
#COVID19foam

1st level of complication = patients vary a lot!
- Most require minimal care
- Many just need low flow oxygen
- Few develop cytokine storm and multiorgan failure
- Many are somewhere in-between

It may be *impossible* to render any blanket statement for all patients. (2/7)

2nd level of complication = disease goes thru phases in any patient

Initially: viral replication phase w/ weak immune response. Immunosuppression *dangerous* here?

Rarely: later surge of adaptive immunity causes cytokine storm. Immunosuppression potentially good here?? (3/7)

Read 7 tweets

Salim R. Rezaie, MD

@srrezaie

Australian Safe Airway Society Consensus Statement of Airway Management and Tracheal Intubation in COVID19 Adult Patients – Preprint Only

bit.ly/3d4Ud77

#COVID19FOAM

Aerosol Generating Procedures

Suggested Contents of COVID-19 Intubation Tray

Read 10 tweets

Discover and read the best of Twitter Threads about #COVID19FOAM

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