An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
On 8/9/21 I put out a tweet discussing (in a certain limited number of characters) how difficult it is to get a patient who is intubated and placed on mechanical ventilation because of severe COVID-19 ARDS. I used the analogy of landing an airplane in a hurricane. Definitely not easy. Something came over me where …
Continue reading Expectations for Families of COVID-19 Patients on the Ventilator
This is a difficult subject to discuss because we all have people we love who suffer from issues that have led to them having a higher weight than what they should and, in turn, carry the diagnosis of obesity. This post is not intended to shame anyone. But there's definitely a link between obesity and …
Continue reading Obesity in Critical Illness & COVID-19: A Very Bad Combination
Those of us who have placed COVID-19 ICU patients on mechanical ventilation know that this is not a process that is going to resolve overnight. Patient with decompensated congestive heart failure with pulmonary edema? Better in 24-48 hours. Aspiration pneumonia in a young kid who partied a little too hard? Better in a few days. …
Continue reading ICU COVID-19 Patients Don’t Get Well Soon, Unfortunately
Yesterday, in the Journal of Cardiothoracic and Vascular Anesthesia, there was a Letter to the Editor by a group of physicians in Italy were where they described the five reasons why people die of COVID-19. I found it quite interesting that this article was published in that particular journal. Given that the audience to my …
Continue reading The five reasons why COVID-19 causes death.
The pendulum has swung when it comes to deciding when to proceed with intubation of our COVID-19 patients when it comes to timing. The early data suggested early intubation was the way to go as we were all terrified or aerosolization of the virus caused by the high-flow nasal oxygen or different modes of non-invasive …
Continue reading Timing of Intubation in COVID-19 Patients: Early or Late?
Update: I will cover the I-TECH study published on 2/18/22 on Ivermectin in COVID-19 Patients soon. The link to the article (but not my thoughts just yet) is down below in the citations. I am on service this weekend and don't have time to tackle it appropriately. Spoiler alert: as much as this is a …
Continue reading Ivermectin Doesn’t Help Healthy Patients with COVID-19
I am not going to belabor this too much but we should stop using azithromycin in the community setting for COVID-19. The rationale for this recommendation was based on an article that was published on 4 March 2021 in the Lancet. The article is titled "azithromycin for community treatment of suspected COVID-19 in people at …
Continue reading Azithromycin in Outpatient COVID-19: Not Recommended
There have been many times during this pandemic where we have tried to reinvent the wheel when it comes to patient care. What we have learned, however, is that returning back to our evidence-based fundamentals have led to the best outcomes. The PROSEVA trial in 2013 showed us that prone positioning in ARDS patients led …
Continue reading Proning Spontaneously Breathing COVID-19 Patients
I am going to be completely honest here and mention that this particular article that I'm going to be looking at today looking at hypothermia in COVID is more for entertainment purposes at this juncture rather than actual data. The paper that I am using as a citation for this post was published on 30 …
Continue reading Hypothermia for ICU COVID-19 Patients? Exploring other options
Today is February 12 of 2021 and I'm gonna be discussing this new not quite yet peer-reviewed article from the recovery trial collaborative group titled “Tocilizumab for COVID-19” or it might be called “Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): Preliminary results of a randomized, controlled, open-label, platform trial. Should we be giving …
Continue reading Tocilizumab for COVID-19: The Return (RECOVERY Group)