Jon-Emile S. Kenny

Dr. Kenny is slowly curating the 'Finnegans Wake of Critical Care Blogs.' His favourite places are: Pier 64, The Hall of Ocean Life, Grand Central Station and the cafe at the top of Fotografiska. He has inherited his grandmother's fascination with the cosmos and Carl Sagan. Enjoy his homage to classical cardiorespiratory physiology at www.heart-lung.org

May 282016
 
The Cerebral Circulation and Sepsis-Associated Delirium

Jon-Emile S. Kenny [@heart_lung] The Journal of Intensive Care has newly published a series of sepsis-related organ dysfunction reviews.  Additionally, a comprehensive yet concise overview of the cerebral circulation was just disseminated.  This summary draws on both of these terrific primary resources as a point-of-departure for discussion of sepsis-associated delirium [SAD]. Cerebral blood flow [CBF] ultimately [… read more]

May 012016
 
ICU Physiology in 1,000 Words: ARDS - Part 2

Jon-Emile S. Kenny [@heart_lung] Gattinoni and Quintel have, very recently, outlined their approach to managing the acute respiratory distress syndrome [ARDS] [1].  They argue that treatment of ARDS should minimize firstly, the mechanical power applied to the lungs – as described in part 1.  Secondly, Gattinoni and Quintel note that, in the treatment of ARDS, [… read more]

Apr 232016
 
Corticosteroids for Community-Acquired Pneumonia

Jon-Emile S. Kenny [@heart_lung] A 66 year old man presents to the emergency department with sudden-onset fevers, chills, and scant hemoptysis.  He is hypoxemic, tachypneic and noted to have egophony with focal crackles and wheezing across his right, anterior chest.  Further, he is found to be in acute kidney injury and his chest x-ray reveals [… read more]

Apr 222016
 
ICU Physiology in 1,000 Words: ARDS - Part 1

Jon-Emile S. Kenny [@heart_lung] “Often, as new knowledge progresses, old knowledge is abandoned or forgotten.” -Luciano Gattinoni In a succinct and current treatise, Gattinoni and Quintel outline the modern management of the acute respiratory distress syndrome [ARDS] [1].  It is imperative, they reason, that treatment of ARDS minimizes firstly, the mechanical power applied to the [… read more]

Mar 182016
 
The Physiologically Difficult Airway – Part 2

Jon-Emile S. Kenny [@heart_lung] In part 2, I continue my commentary on this excellent review; part 1 may be found here.  In this post I will consider patients with severe metabolic acidosis and those with right ventricular [RV] dysfunction and/or failure. Severe Metabolic Acidosis In patients with severe metabolic acidosis, alveolar ventilation tends to be maximal [… read more]

Mar 112016
 
The Physiologically Difficult Airway – Part 1

Jon-Emile S. Kenny [@heart_lung] To celebrate the birthday of Dr. Erin Hennessey [@ErinH_MD] – my former co-fellow and current Stanford intensivist-anesthesiologist – I will interpret a relatively recent and terrifically high-yield overview of physiologically challenging intubations.  In this must-read survey, the authors highlight particularly troublesome intubations not from the classic, anatomical perspective, but from the [… read more]

Mar 012016
 
An Expected or Maladaptive Response to Infection?  Sepsis Reconsidered

Jon-Emile S. Kenny [@heart_lung] “A man may take to drink because he feels himself to be a failure, and then fail all the more completely because he drinks … English … becomes ugly and inaccurate because our thoughts are foolish, but the slovenliness of our language makes it easier for us to have foolish thoughts.” [… read more]

Feb 172016
 
Recruitment Maneuvers & PEEP in the Morbidly Obese

Jon-Emile S. Kenny [@heart_lung] A recent study of applied respiratory physiology in the mechanically-ventilated, obese patient was published.  The ubiquitous focus on lung protective ventilation with “low” [physiological] lung volumes, and low plateau pressure may leave the obese patient susceptible to untoward respiratory embarrassment.  Excess abdominal and chest wall weight affect each of the following: [… read more]

Feb 132016
 
ICU Physiology in 1000 Words: Driving Pressure & Stress Index

By Jon-Emile S. Kenny [@heart_lung] The problem with the lung in the acute respiratory distress syndrome [ARDS] is not that it is stiff, but rather, that it is small [1].  In the 1980s, CT scans of the lungs of patients with ARDS revealed that the functional lung was attenuated in size and that dependent densities [… read more]

Jan 212016
 
That Fallible IVC

Jon-Emile S. Kenny [@heart_lung] A 58 year old man with ethanol-related cirrhosis is admitted to the floor with anuria and a rising creatinine.  Over the day, serial ultrasounds of his interior vena cava [IVC] consistently reveal that it is diminutive and collapsing.  He receives many liters of crystalloid without much change in his urine output.  [… read more]

Jan 172016
 
Review: Lactate & Sepsis

Jon-Emile S. Kenny [@heart_lung] On this snowy, Stockholm Sunday, I look out from my quarters on the Mälardrottningen across the still, icy waters and I think about a cirrhotic patient for whom I recently cared.  She presented with significant dyspnea as she had stopped taking her diuretics.  Instead, she was using excessive doses of her friend’s [… read more]

Aug 012015
 

ICU Physiology in 1000 Words Veno-Arterial Extra-Corporeal Membrane Oxygenation (VA-ECMO) Jon-Emile S. Kenny M.D. [@heart_lung] Perhaps the most memorable patient of both my pulmonary and critical care fellowships was that of a very young woman who suffered from propofol-related infusion syndrome [PRIS]. As a consequence of PRIS, she endured multiple cardiac arrests and was placed [… read more]

Mar 192015
 
ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 2 of 2)

ICU Physiology in 1000 Words The Right Ventricular Afterload [Part 2 of 2] Jon-Emile S. Kenny M.D. [@heart_lung] Having considered the short-comings of Laplace’s Law and the PVR with respect to the RV afterload in part 1, we will now turn to each of the following in turn: the pulmonary arterial input impedance, a measureable [… read more]

Mar 132015
 
ICU Physiology in 1,000 Words: Right Ventricular Afterload (Part 1 of 2)

ICU Physiology in 1,000 Words: The Right Ventricular Afterload (Part 1 of 2) By Jon-Emile S. Kenny M.D. With my trusted-resident – Dr. Lina Miyakawa – at my side we watched as our patient could not maintain his oxygen saturation above 82%. The patient had terrible aspiration pneumonia superimposed upon horrendous methamphetamine-related pulmonary arterial hypertension [… read more]

Feb 012015
 
ICU Physiology in 1,000 Words: Cardiopulmonary Resuscitation

Cardiopulmonary Resuscitation by Jon-Emile S. Kenny, MD The first time I performed cardiopulmonary resuscitation [CPR] on a patient was in the emergency department of Sunnybrook Hospital in Toronto, Canada; it was certainly an indelible moment in my training. As an intern, and especially as medical consult at Bellevue Hospital in New York City, I was [… read more]

Dec 052014
 

In Defense of the Central Venous Pressure Jon-Emile S. Kenny M.D. In the waning days of my fellowship I received a hemoptysis consult in the cardiac care unit. Sifting through CT scans, I overheard two house-officers giving sign-out for the evening. When reviewing the clinical data, one of the residents referred to the central venous pressure [… read more]

Oct 162014
 
ICU Physiology in 1,000 Words: Stroke Volume Variation and the Concept of Dose-Response

Stroke Volume Variation and the Concept of Dose-Response Jon-Emile S. Kenny M.D. Awareness of the undulating pattern of an arterial line tracing is high amongst health professionals in the intensive care unit; certainly this is an aftereffect of a cacophony of studies and reviews pertaining to pulse pressure variation and fluid responsiveness in the operating [… read more]