Review Articles

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]

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]

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]

Dec 212019
 
ICU Physiology in 1000 Words: Asthmatic Mechanics

Jon-Emile S. Kenny MD [@heart_lung] Recently, Josh Farkas and Scott Weingart gave a series of engrossing posts and podcasts on asthma.  I especially liked their deliberations on mechanical ventilation which inspired me – no pun intended – to create a vodcast of my own and, like a novice troubleshooting a ventilator alarm, poke and prod at [… 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]

Dec 062019
 
Navigational bronchoscopy real-world diagnostic yields reported

Electromagnetic navigation bronchoscopy (ENB) can allow biopsy of peripheral pulmonary nodules that are usually not accessible with conventional bronchoscopy. Navigational bronchoscopy requires specialized training and equipment costing hundreds of thousands of dollars, and is not widely available outside urban centers. Multiple studies have reported varying yields and complication rates with ENB, but most have been [… read more]

Nov 302019
 
ICU Physiology in 1000 Words: Pulmonary Embolism & Right Ventricular Ischemia

Jon-Emile S. Kenny MD [@heart_lung] Commonly, we are sold that acute pulmonary thromboembolism [PE] burns the right ventricular [RV] candle at both ends.  This is because perfusion of the right coronary artery [RCA] is mediated by both its upstream mean arterial pressure [MAP] and downstream right ventricular end-diastolic pressure [RVEDP].  Given that a PE may decrease [… read more]

Nov 242019
 
ICU Physiology in 1000 Words: Pulmonary Embolism & Pulmonary Vascular Resistance

Jon-Emile S. Kenny MD [@heart_lung] What if I told you that in acute pulmonary thromboembolism [PE] that the initiation of intravenous norepinephrine [NE] decreases the calculated pulmonary vascular resistance [cPVR]?  Would you believe me?  Certainly, you would trust that an infusion of a thrombolytic does so.  Of great interest, both NE and thrombolytics decrease the cPVR [… read more]

Nov 112019
 
ICU Physiology in 1000 Words: Pulmonary Embolism & Syncope

Jon-Emile S. Kenny MD [@heart_lung] The transient and reversible loss of consciousness that may accompany pulmonary embolism [PE] is well-documented [1-7].  This brief post will not address the controversy regarding the prevalence of PE in ‘unexplained’ syncope; rather, it will focus on pathomechanisms and serve as the foundation for a few forthcoming entries on pulmonary thromboembolism [… read more]

Nov 082019
 
New guidelines on obesity hypoventilation syndrome released

Tens of millions of adults in the U.S. have obstructive sleep apnea (OSA), but most are mild cases that pose low health risks. A greater danger is faced by the smaller number of people with sleep apnea that progresses to obesity hypoventilation syndrome (OHS), a life-threatening condition. Obesity hypoventilation syndrome — an impairment in resting [… read more]

Oct 302019
 
Vaping-Associated Lung Injury – Part 2

Jon-Emile S. Kenny MD [@heart_lung] “There are sadistic scientists who hurry to hunt down errors instead of establishing the truth.” -Marie Curie In part 1 of Vaping-Associated Lung Injury, the very basics of electronic nicotine delivery systems [ENDS] were covered as well as highlights on clinical presentation, radiology and pathology.  In this second part, flurries of [… read more]

Oct 292019
 
Vaping-Associated Lung Injury – Part 1

Jon-Emile S. Kenny MD [@heart_lung] with illustration by Carla M. Canepa MD [@_carlemd_] “Inside the word ‘emergency’ is ‘emerge’; from an emergency, new things come forth.” -Rebecca Solnit Case A 32-year-old man is admitted with three days of fevers, chills, malaise, dyspnea and productive cough.  He works in a stressful job in the heart of Manhattan [… read more]

Oct 212019
 
2019 IDSA Guidelines for Community Acquired Pneumonia in Adults: To HCAP, we just say fare thee well

Jon-Emile S. Kenny MD [@heart_lung] with illustrations by Carla M. Canepa MD [@_carlemd_] “Better never means better for everyone… It always means worse, for some.” -Margaret Atwood Case A 73-year-old woman with a history of severe chronic bronchitis, ESRD receiving thrice-weekly hemodialysis and heart failure with a preserved ejection fraction is admitted from home with fevers, [… read more]