Discover and read the best of Twitter Threads about #NiV
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Yesterday we published our first combined asthma and COPD 'Drawing Breath' @NACAPaudit report.
I thought I'd highlight a few key themes.
First, it's important to note that these data reflect care during the pandemic period when front line clinical teams were stretched...
Yesterday we published our first combined asthma and COPD 'Drawing Breath' @NACAPaudit report.
I thought I'd highlight a few key themes.
First, it's important to note that these data reflect care during the pandemic period when front line clinical teams were stretched...
We have four key recommendations, each relevant to #asthma in adults, asthma in children and young people and #COPD, including #PR services.
The first area is that everyone should be able to access early and accurate diagnosis. Here are some key findings; we need to do better:
The first area is that everyone should be able to access early and accurate diagnosis. Here are some key findings; we need to do better:
The second theme is the need for TIMELY care when a person has been admitted to hospital, for example receipt of systemic steroids in asthma, or #NIV in COPD for those who need it.
Next :: Claude Guerin. Covid v non covid and NIV. #LIVES2022 #ventilation #NIV @ESICM summarising risk factors for NIV failure - old age, multi organ failure etc. then diving straight into “Happy Hypoxemia”.
Re-visiting H and L phenotypes. Silent or happy hypoxemia. So best to proceed by undertaking in depth literature search
But the evidence tends to suggest covid has higher mortality and is also v heterogeneous.
Four “burning” questions on NIV @DrLeoHeunks - does NIV worsen lung injury ? #LIVES2022 #ventilation #niv @ESICM
This is an important question as “harm” from prolong NIV without being able to protect lungs. Assess Tidal volume during NIV. “High TV independent risk factor for NIV failure “. NOT causation but important observation.
Of course Leo comes back to Tonelli article using oesophageal catheter in de novo Resp failure NIV. 😍😍😍this study. Normal 4-5 cmH2o. These patients have very high effort ~20. What’s remarkable is the change in first 2 hours !
NEXT :: COPD - Oriole Roca.
Evidence : NIV is great for acute COPD. The classic from Laurent Brochard pubmed.ncbi.nlm.nih.gov/7651472/
Evidence : NIV is great for acute COPD. The classic from Laurent Brochard pubmed.ncbi.nlm.nih.gov/7651472/
but if beyond 24 hours. alternative is High flow nasal cannulae.
#LIVES2022
#ventilation
#NIV #COPD @ESICM
#LIVES2022
#ventilation
#NIV #COPD @ESICM
@ESICM NIV failure - intubat the patient, COPD patient intubated, Vol Control, 7ml/kg PBW, I:E = 1:4 , RR 20. Then patient is "hypotensive". why?
Day 2 PM session : Advanced monitoring in acute Resp failure. Opening on #NIV Non invasive support - Domenico and Oriol Rica. #LIVES2022
#ventilation
ARF: NIV evidence clear In acute cariogenic pulmonary oedema / hypercapnia ARF. not so clear in hypoxemic ARF
#ventilation
ARF: NIV evidence clear In acute cariogenic pulmonary oedema / hypercapnia ARF. not so clear in hypoxemic ARF
starting with a case : 55,male,no PMH. SOB in 2/days, fever 1/ week. PaO2 11(90), 10 l o2 facemask, PaCO2 3.7 (28), pH 7.48, lac 1.5, RR 33, BP 140/70, HR 130bpm sinus. CXR: four quadrant consolidate changes. Immediate thoughts?
Q. what's the estimate of FiO2? 3% formula FiO2 fairly good estimate.
pubmed.ncbi.nlm.nih.gov/32522764/
pubmed.ncbi.nlm.nih.gov/32522764/
When talking about jeopodising 'National Security', are they referring to jeopodising their hidden arrangements with 'other' National Security Agencies?
#Chinese Major-General worked with fired scientist at #Canada’s top #infectious disease lab.
google.com/amp/s/www.theg…
google.com/amp/s/www.theg…
Now @lyvonnetume answering the question for feeding children (or not) when they are on non-invasive ventilation...
It’s not should we... it should be how do we feed...
#PedsICU #EPCCS20
It’s not should we... it should be how do we feed...
#PedsICU #EPCCS20
What does the data say already on the topic of feeding #PedsICU patients on non-invasive ventilation?
@lyvonnetume #EPCCS20
@lyvonnetume #EPCCS20
@lyvonnetume now describes the research her team have carried out to identify feeding practices and calorie target for #PedsICU on #NIV
#EPCCS20
#EPCCS20
1/
I want to thank all my colleagues for the wonderful #COVID19 research they published during these months: >200 PubMed-indexed articles from @SanRaffaeleMI @SRAnesthesiaICU @MyUniSR @azangrillo
I’ll summarize few of them in this thread.
I want to thank all my colleagues for the wonderful #COVID19 research they published during these months: >200 PubMed-indexed articles from @SanRaffaeleMI @SRAnesthesiaICU @MyUniSR @azangrillo
I’ll summarize few of them in this thread.
2/
In February, before the start of #COVID19 in Europe, we suggested the use of helmet to deliver #CPAP #NIV in emergency departments. This can be a key issue to prevent future spread of respiratory pandemics in emergency departments.
thelancet.com/journals/lance…
In February, before the start of #COVID19 in Europe, we suggested the use of helmet to deliver #CPAP #NIV in emergency departments. This can be a key issue to prevent future spread of respiratory pandemics in emergency departments.
thelancet.com/journals/lance…
3/
As soon as #COVID19 spread in Lombardy we helped other centers to manage their worst patients: 39 patients from other centers were admitted in our ICUs. The H was reshaped to cope with the new situation. The manusc cited 38 times in the first 4 months.
As soon as #COVID19 spread in Lombardy we helped other centers to manage their worst patients: 39 patients from other centers were admitted in our ICUs. The H was reshaped to cope with the new situation. The manusc cited 38 times in the first 4 months.
My experience: #Covid_19 ICU rotation at #SGPGI #Lucknow
1. All patients were >35 years of age with majority being males
2. Apart from the usual comorbidities, central #obesity without over #diabetes or #hypertension also predisposed to #SARI
1. All patients were >35 years of age with majority being males
2. Apart from the usual comorbidities, central #obesity without over #diabetes or #hypertension also predisposed to #SARI
3. #Lymphopenia was a great marker of severity and a rising trend predicted clinical recovery
4. #recoverytrial further reiterated the use of steroids for patients with severe disease which many centers including ours was already practising
4. #recoverytrial further reiterated the use of steroids for patients with severe disease which many centers including ours was already practising
5. Although initially we had a guarded approach towards it, but #NIV with low pressures worked wonders avoiding intubation
6. Once intubated, outcomes aren’t great. Multiple reasons: severity of disease, nursing care and feeding becomes suboptimal, bradycardia associated with
6. Once intubated, outcomes aren’t great. Multiple reasons: severity of disease, nursing care and feeding becomes suboptimal, bradycardia associated with
Starting a series on clinical Pearls I am gathering in #COVID19 patients based on experiences of many experts
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Will add as we go along
Feel free to add your own observations/experiences
#covidclinicalpearls /1
Anosmia is likely the most specific #COVID19 related symptom
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
30% of patients have anosmia as their 1st symptom
#covidclinicalpearls /2
Around 90% of patients have fever.
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
50% maybe afebrile at the time of presentation
Fever tends to be very resistant to routine measures in hospitalized patients
There is no consensus that NSAIDs are to be avoided in #COVID2019 patients
#covidclinicalpearls /3
If done well, contact tracing and case isolation is enough to control a #COVID19 in India over 3 months. Delays in identifying cases and incomplete contact tracing results in decreased probability of interrupting the transmission. thelancet.com/journals/langl… 1ofn #Covid19India
Under best-case assumptions, screening will miss more than half of infected people. Most cases missed by screening are undetectable because they have not yet developed symptoms, are unaware they were exposed or have taken paracetamol to mask fever. ncbi.nlm.nih.gov/pmc/articles/P… 2ofn
#India has done exceptionally well in changing the course of what could have been a potentially devastating outbreak. Thanks to @ProfBhargava @ICMRDELHI @icmr_nie @Director_NCDC for the extraordinary measures and leadership in tackling the evolving situation. #Covid19India 3ofn
1/11
Short #Tweetorial
How did we started with heated humified high flow nasal cannula in 🇺🇾 ?
Easy explanation of 3 #HHHFNC homemade models #HFNC devices?
(No COI to declare)
#PedsICU #SoMe4MV #historyofmedicine @WFPICCS
Short #Tweetorial
How did we started with heated humified high flow nasal cannula in 🇺🇾 ?
Easy explanation of 3 #HHHFNC homemade models #HFNC devices?
(No COI to declare)
#PedsICU #SoMe4MV #historyofmedicine @WFPICCS
2/
It is really easy.
You can get information of its uses and applications in this nice review in @respcare ▶️ncbi.nlm.nih.gov/pubmed/27016353
This is basically the diagram 👇
It is really easy.
You can get information of its uses and applications in this nice review in @respcare ▶️ncbi.nlm.nih.gov/pubmed/27016353
This is basically the diagram 👇
3/
So back in 2012 in our country we wanted to try some kind of respiratory support for the youngest infants in which interfases for #NIV was difficult.
SO we came up with an idea: What if we dismantle the old ventilators we do not use any more?
Like this ones 👇
So back in 2012 in our country we wanted to try some kind of respiratory support for the youngest infants in which interfases for #NIV was difficult.
SO we came up with an idea: What if we dismantle the old ventilators we do not use any more?
Like this ones 👇
