Infectious Disease and Sepsis

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]

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]

Oct 102020
 
ICU Physiology in 1000 Words: The Diastolic Shock Index & Subendocardial Perfusion

Jon-Emile S. Kenny MD [@heart_lung] When we model the circulation at the bedside, we resort to generalizations.  While these mechanistic heuristics don’t completely capture the complexity of hemodynamics, they do help us think quickly when confronted by clinical urgency.  For example, distilling ‘venous return’ into an upstream pressure and downstream pressure separated by a single resistance, [… read more]

Sep 122020
 
More on Corticosteroids in COVID-19 – Part 2: REACT meta-analysis

Jon-Emile S. Kenny MD [@heart_lung] “As human beings, don’t we need questions without answers as well as questions with answers?” -Alan Lightman With the publication of REMAP-CAP, CAPE-COVID and CoDEX, the World Health Organization [WHO] Rapid Evidence Appraisal for COVID-19 Therapies [REACT] Working Group combined these results with 4 other randomized trials of corticosteroids in COVID-19.  [… read more]

Sep 102020
 
More on Corticosteroids in COVID-19 – Part 1: REMAP-CAP, CAPE-COVID & CoDEX trials

Jon-Emile S. Kenny MD [@heart_lung] “Let us try to assume our fundamental ambiguity.” -Simone de Beauvoir When the pre-peer review RECOVERY trial was released in mid-June of this year, clinicians lost equipoise to enroll hospitalized patients receiving at least oxygen for COVID-19 into trials including a treatment arm without corticosteroids.  This brought to an early-halt three [… read more]

Sep 062020
 
Vitamin C, steroids, thiamine for septic shock: no benefit in ACTS trial

A combination of vitamins C and B1 with corticosteroids didn’t prevent organ failure in septic shock, the ACTS trial showed. The intervention improved the Sequential Organ Failure Assessment (SOFA) score 4.7 points compared with a 4.1-point improvement with placebo over the 72 hours after enrollment, which was not significant at P=0.12 for interaction, reported Michael Donnino, [… read more]

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]

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]

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]

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 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 122019
 
Patients who say they're allergic to penicillin are usually wrong

More than 32 million people in the U.S. have reported penicillin allergies — about 10% of the population. But almost 95% of them are not penicillin-allergic, and are removing themselves from eligibility for ideal antibiotic treatments, according to a review in JAMA. “More than 1 in 10 people who seek medical care self-report a history [… read more]

Nov 082019
 
Can C-reactive protein improve treatment for COPD exacerbations?

Use of C-reactive protein (CRP) in decision-making may reduce antibiotic use in COPD exacerbations, but not as a replacement for clinical judgment, a study suggested. Chronic obstructive pulmonary disease (COPD) exacerbations are characterized by increased inflammation in the airways and the body generally. C-reactive protein (CRP) is a serum test for inflammation, and has been [… read more]

Nov 072019
 
In sepsis, antibiotics reduced yield of blood cultures by almost 40%

by Molly Walker, Associate Editor, MedPage Today If you want an accurate reading from sepsis patients’ blood cultures, don’t start antibiotics until you’ve drawn the blood samples, a new study suggested. Among patients with severe sepsis, blood cultures taken prior to antibiotic therapy were positive for one or more microbial pathogens in 31.4% of patients [… read more]

Oct 312019
 
Vitamin C reduces mortality from sepsis with ARDS in CITRIS-ALI randomized trial ... ?

Vitamin C infusion has generated tremendous interest as an adjunctive treatment for patients with sepsis, since a widely publicized cohort study claimed vitamin C dramatically reduced sepsis-related mortality at a single institution. The publicity, the plausible pathophysiologic mechanism, and the lack of any therapy for sepsis have led many intensivists to prescribe the so-called Marik [… read more]