Jan 052022
 
What Minimal Volume of Intravenous Fluid Challenges the Heart?

Jon-Emile S. Kenny MD [@heart_lung] “I find real life challenging enough.  If I get to the dry cleaners without having a huge fight, that’s challenging enough.” -Fran Lebowitz  Background Quite recently, the BaSICS investigators evaluated the infusion rate of a fluid bolus on patient outcome.  As considered, however, contrast should be made between a fluid bolus, [… read more]

Jan 022022
 
COVID STEROID 2 Trial Investigates Dexamethasone 6 mg or 12 mg in COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “If you’re afraid of butter, use cream.” -Julia Child  Background Early observational studies and the RECOVERY collaborative group initially demonstrated the benefit of corticosteroid therapy in oxygen-requiring, COVID-19-patients; additional randomized studies as well as a meta-analysis of these reports corroborated this. Yet the dosing of corticosteroids across the above studies was [… read more]

Dec 312021
 
Fact-Checking Buffalo Chest

Jon-Emile S. Kenny MD [@heart_lung] “It was after this realization that I began trying to find the ‘point’ of California, to locate some message in its history.” -Joan Didion  Background A few months ago, I found myself in one of my favourite places – the American Museum of Natural History in New York City.  Meandering through [… read more]

Nov 182021
 
PRINCIPLE Investigators Study Inhaled Budesonide for COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “… Sartre tells us that man makes himself this lack of being in order that there might be being.” -Simone de Beauvoir  Background Like many early, proposed therapies for COVID-19, inhaled corticosteroids [ICS] had suggestive, conflicting evidence.  For example, in a very large observational investigation – the OpenSAFELY platform – patients with both [… read more]

Nov 112021
 
ICU Physiology in 1000 Words: Phenylephrine Pushes & Stroke Volume

Jon-Emile S. Kenny MD [@heart_lung] About a decade ago, a handful of terrific reviews and investigations about phenylephrine – an alpha1 agonist – were published [1-3].  While this vasoactive medication might be thought only to ‘increase afterload,’ phenylephrine’s hemodynamic effects are knotty and noteworthy.  Therefore, this dedicated dispatch delineates the difficulties encountered when predicting the hemodynamics [… read more]

Oct 312021
 
The TOGETHER Trial Evaluates Fluvoxamine for COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “In those years, truth was elusive – as was my own faith that I could recognize and contain it.” -Mary Oliver Previously, the very basic underpinnings of fluvoxamine as a pharmacological method to quell cytokine unruliness was outlined.  In brief, fluvoxamine is a sigma-1-receptor [S1R] agonist – an effect that opposes [… read more]

Sep 232021
 
ICU Physiology in 1000 Words: The Geometry of Ejection Fraction

Jon-Emile S. Kenny MD [@heart_lung] The left ventricular ejection fraction [LVEF] is a commonly-sought cardiac measure.  With the explosion of bedside ultrasound and automated methods to capture LVEF, the ejection fraction will grow in clinical prominence and affect decisions for the acutely-ill.  Asked the meaning of the LVEF, many clinicians might describe it as a ‘measure [… read more]

Sep 132021
 
ICU Physiology in 1000 Words: The Pulse

Jon-Emile S. Kenny MD [@heart_lung] The relative simplicity of extending one’s finger onto the tissue overlaying a major artery belies the complicated forces generating an arterial pulse.  Descriptions and physiological elucidations have been put forth across the decades, yet even today the machinations relating cardiac contraction to a waxing and waning arterial wall are a bit [… read more]

Sep 092021
 
Back to the BaSICS: does the infusion rate of a fluid bolus affect mortality?

Jon-Emile S. Kenny MD [@heart_lung] “He walked away across the room, his cowboy boots echoing like pistol shots.” -Sylvia Plath Background Implicit in resuscitation is speed.  Throughout training we are zealously instructed that ‘time is tissue’ for all manners of compromised perfusion. We envision spendthrift mitochondria chewing through oxygen without regard to withering supply; as such, [… read more]

Sep 012021
 
Another 0.9% Saline versus Balanced Solution Trial: BaSICS released

Jon-Emile S. Kenny MD [@heart_lung] “May I be the tiniest nail in the house of the universe, tiny but useful.” -Mary Oliver Background The use of ‘balanced’ intravenous fluids as compared to 0.9% saline – so-called ‘normal’ saline – has garnered much scientific interest in the last half-decade.  Propelling some of this curiosity is a newfound [… read more]

Jul 212021
 
Heat Exhaustion & Heatstroke – part 2

Jon-Emile S. Kenny MD [@heart_lung] “There are hills, rounded, blunt, burned, squeezed up out of chaos, chrome and vermilion painted, aspiring to the snow-line.” -Mary Austin With very basic introductions to heat transfer, the cardiovascular response to heat stress and the distinction between heat exhaustion and heatstroke, this final section addresses fundamental aspects of treating heat-related [… read more]

Jul 202021
 
Heat Exhaustion & Heatstroke – part 1

Jon-Emile S. Kenny MD [@heart_lung] “Tell me, what is it you plan to do, with your one wild and precious life?” -Mary Oliver When carbon dioxide retention tickles intensivists’ neurons, clusters of adjacent synapses spark in deep sulci – discharging neural silos of respiratory physiology, alveolar ventilation, pH interpretation and the like. But like flash-bulbs against [… read more]

Jul 202021
 
Heat-Related Illness & Hemodynamics

Jon-Emile S. Kenny MD [@heart_lung] “I believe that the very process of looking can make a thing beautiful.” -David Hockney With the basics of temperature, heat and heat transfer described previously, this section turns to some select physiological aspects of heat-related illness. While this is clearly a very broad topic with multiple, intersecting avenues of discussion, [… read more]

Jul 192021
 
Heat-Related Illness & First Principles

Jon-Emile S. Kenny MD [@heart_lung] “Study hard what interests you the most in the most undisciplined, irreverent and original manner possible.” -Richard Feynman Heat-related illness is a very common form of environmental injury. Like many insults, it may be modelled by ‘diathesis-stress.’ In other words, heat-related illness materializes at the cross-roads of inherent patient characteristics [e.g., [… read more]

Mar 312021
 
On Cytokines, Fluvoxamine and COVID-19 – Part 2

Jon-Emile S. Kenny MD [@heart_lung] “Apocalypse is played out now on a personal scale; it is not in the sky above us, but in our bed.” -Mark Doty Introduction With a proposed pathway coupling pathogen-associated molecular patterns to the elaboration of pro-inflammatory cytokines, sketched lightly in part 1, this segment ties murine biomolecular theory to human [… read more]

Mar 282021
 
On Cytokines, Fluvoxamine and COVID-19 – Part 1

Jon-Emile S. Kenny MD [@heart_lung] “You see, we have a kind of allergy to the past; it’s our national disease, and the very assurance with which you insist that the past is within the present is likely to seem quite repellent, even offensive, to these new readers.” -Richard Howard Introduction Early in the COVID-19 pandemic, the [… read more]

Feb 172021
 
Open Critical Care: a great new hub for critical care resources

I’m excited to share the link to Open Critical Care, a new hub providing open access critical care learning tools, COVID-19 treatment guidelines, and loads of other high-quality resources. Funded by USAID and directed by physicians at UCSF, it’s an endeavor worth following. Although their offerings are directed especially toward health care workers in resource-variable [… read more]

Jan 292021
 
A Cursory Review of Casirivimab and Imdevimab for COVID-19

Jon-Emile S. Kenny MD [@heart_lung] “Booksellers are the most valuable destination for the lonely, given the numbers of books that were written because authors couldn’t find anyone to talk to.” – Alain de Botton Introduction An important reason for treating both tuberculosis and HIV with multiple pharmacological agents is the ability of these infectious scourges to [… read more]

Jan 082021
 
Kambô Intoxication for the Intensivist – Part 2

Jon-Emile S. Kenny MD [@heart_lung] “There are poisons that blind you, and poisons that open your eyes.“ – August Strindberg. In the introduction to kambô, or what Esparmer and colleagues called a “fantastic chemical cocktail with potential medical applications, unequaled by any other amphibian,” a superficial overview was offered. This first part included a very basic [… read more]