Jun 302020
 
A Brief Overview of Corticosteroids in COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “ This is the way the world ends Not with a bang but with a whimper.” -T.S. Eliot As lightly discussed a few months ago, deploying corticosteroids in COVID-19 began, expectedly, with controversy.  Russell and colleagues submitted a letter arguing against wholesale administration of corticosteroids in patients infected with SARS-CoV-2.  They [… read more]

Jun 282020
 
A Brief Update on Angiotensin & Aldosterone Inhibition in COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “We’re on a road to nowhere …” -David Byrne Background In early March of this year, Fang and colleagues published a letter noting that patients with diabetes and/or hypertension treated with ACE inhibitors or angiotensin II type-1 receptor blockers [i.e. ARBs] increase their expression of the ACE2 enzyme.  Parenthetically, they also stated [… read more]

May 302020
 
COVID-19 Associated Coagulopathy: a contentious conundrum

Jon-Emile S. Kenny MD [@heart_lung] “Knavery and flattery are blood relations.” -Abraham Lincoln Background SARS-CoV-2 is a positive-sense, single-stranded RNA virus with spiked surface glycoproteins  emanating from its viral envelope.  It is a member of the Coronaviridae family, similar to the first SARS [SARS-CoV] and the Middle East Respiratory Syndrome [MERS].  SARS-CoV-2 preferentially targets respiratory epithelium, [… read more]

May 242020
 
Does the 65 Trial Dial Down the Mean Arterial Pressure in Sepsis?

Jon-Emile S. Kenny MD [@heart_lung] “This whole thing is not about heroism.  It’s about decency.  It may seem a ridiculous idea, but the only way to fight the plague is with decency.” -Albert Camus Background In 2013, Dünser and colleagues communicated a rogue viewpoint in shock resuscitation – let us do away with strict macro-hemodynamic goals [… read more]

Apr 302020
 
COVID-19 Associated ARDS: ‘CARDS’ & the L-Phenotype

Jon-Emile S. Kenny MD [@heart_lung] “No facts are to me sacred; none are profane; I simply experiment, an endless seeker with no Past at my back.” -Ralph Waldo Emerson Background  When Drs. Marini and Gattinoni author a letter describing a new phenotype of the acute respiratory distress syndrome [ARDS] encountered in patients infected with SARS-CoV-2, we [… read more]

Mar 252020
 
An Illustrated Primer on COVID-19 Therapy: part 2

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “…fires had been put out by volunteers using brickmason’s ladders and buckets of water carried in from wherever it could be found, and methods so disorderly that they sometimes caused more damage than the fires.” – Gabriel García Márquez In this second primer [… read more]

Mar 212020
 
An Illustrated Primer on COVID-19 Therapy: part 1

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “…but they all had an evasive tremor in their voices and an uncertainty in their eyes that belied their words.” – Gabriel García Márquez Background  With early data illustrating upwards of 1 in 5 COVID-19 patients developing acute respiratory distress syndrome [ARDS], there is [… read more]

Mar 162020
 
An Illustrated Guide to the Chest CT in COVID-19

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “He found a glimmer of hope in the ruins of disaster …” – Gabriel García Márquez Background  The coronavirus moniker originates from the appearance of the virus under the electron microscope – protein peplomers radiating from the viral envelope like a crown.  Prior [… read more]

Mar 092020
 
ICU Physiology in 1000 Words: All Perfusion Is Local

Jon-Emile S. Kenny MD [@heart_lung] About a year ago, I explored blood pressure – underscoring mean arterial pressure [MAP] as a determinant, but not necessarily an indicator, of perfusion.  The inspiration for that post were these excellent reviews [1, 2] by the legendary Dr. Magder. With the recent 65 Trial [3], a deeper exploration of tissue [… read more]

Feb 092020
 
Vitamin C didn't improve septic shock in VITAMINS trial

A new randomized trial showed no benefit from intravenous vitamin C in patients with sepsis, but delays in treatment baked into the trial design will keep hope alive for true believers in the novel therapy. Vitamin C, hydrocortisone, and thiamine have been promoted as a lifesaving adjunctive therapy for septic shock, based on anecdotal data [… read more]

Feb 092020
 
The ‘Lacto-Bolo Reflex’

Jon-Emile S. Kenny MD [@heart_lung] “Sich regen bringt Segen” -German proverb Background It is an overcast day in Bern, Switzerland.  I have recently left Zermatt, having had the honour and pleasure of speaking at ‘The Big Sick’ conference.  I spent the day roaming the narrowed passages of this old, beautiful city.  In the midst of my [… read more]

Jan 202020
 
Adding Vitamin D no help in critical illness, even in deficient patients

Vitamin D supplementation brought no measurable benefits to vitamin D-deficient critically ill patients, in a large randomized trial published in the New England Journal of Medicine. Vitamin D supplementation has long been hoped for as a potential lifesaving therapy in critical illness. Many critically ill patients are vitamin D deficient, and deficiency increases the risk [… read more]

Jan 132020
 
PulmCCM's Best of 2019

Best of 2019 on PulmCCM: Keep O2 saturations at 96% or below for hospitalized patients, says expert panel Major asthma guideline update: ICS-LABA as-needed replaces albuterol 2019 IDSA Guidelines for Community Acquired Pneumonia Prolonged hypothermia improved neurologic outcomes after non-shockable cardiac arrests Hospitals should not implement one-hour sepsis bundles, say SCCM and ACEP Vitamin C [… read more]

Jan 062020
 
ICU Physiology in 1000 Words: Shorthand Equations for Respiratory System Power

Jon-Emile S. Kenny MD [@heart_lung] Background This synopsis will address the basic geometric calculation of respiratory system work for a single breath [in joules] and power [i.e. joules/seconds or watts] which is work multiplied by the respiratory rate.  This geometric approach will then be used to explain two shorthand equations – the second of which was [… read more]

Jan 052020
 
New Guideline for Treatment of Drug-Resistant Tuberculosis

New Guideline Emphasizes Treatment of Drug-Resistant Tuberculosis with All-Oral Regimens for MDR-TB Patients The American Thoracic Society, Centers for Disease Control and Prevention, European Respiratory Society and the Infectious Diseases Society of America have published an official clinical guideline on the treatment of drug-resistant tuberculosis (DR-TB) in the Nov. 15 American Journal of Respiratory and [… read more]

Jan 052020
 
Non-tuberculous mycobacterial disease increasing across U.S.

by Zeena Nackerdien PhD, CME Writer, MedPage Today Recent estimates point to a rise in NTM lung disease in the U.S., particularly among those older than 50 or those with chronic underlying lung diseases, such as non-cystic fibrosis bronchiectasis, cystic fibrosis, and emphysema. According to a 1997-2007 estimate of the Medicare population (≥65 years old), NTM lung [… read more]

Dec 272019
 
The PHARLAP Trial: Recruitment Maneuvers Buy Stairway to Heaven?

Jon-Emile S. Kenny MD [@heart_lung] “Dying is a wild night and a new road.” -Emily Dickinson Background In 2006, a recruitment maneuver to achieve an ‘open lung’ was circulated; it has since been dubbed ‘stairway recruitment’ given its stepwise upthrusts in airway pressure [see figure 1]: Plodding up this ladder of airway pressure was meant to [… read more]