transition to CPAP if HFNC isn't working. we're looking at high FiO2 and low PEEP, and also no added fluids. (logic being: lung recruitment isn't the primary problem, so pressure won't help; hypoxemia is severe and hypercapnia pretty rare, so more oxygen is better)
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"divorce FiO2 from PEEP" -- at least in type L. this is a *different* ventilatory protocol than ARDSNet, because these aren't typical ARDS patients. If you don't have collapsed alveoli in the first place, extra pressure can cause barotrauma.
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does remdesivir work? that recent NEJM study is SUPER USELESS FOR ANSWERING THAT QUESTION. (ed: just what I thought!)
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but ok, 57% of remdesivir-treated patients that were intubated got to be extubated, which is a lot higher than typical base rates. but hey, no control group, we don't know what to make of this.
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"as many of you have noticed, we have many COVID-positive patients." god i love the gallows humor. Clinical trial recruitment should be a lot easier these days!
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should you treat COVID19 pneumonia with antibiotics? dr. laughs, who's gonna send a person with CT evidence of pneumonia home without antibiotics?!
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recent evidence says high-dose chloroquine causes cardiac issues & it isn't looking too effective either.
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do we want to be giving anti-IL6 receptor antibodies to deal with cytokine storms? like tocilizumab.
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retrospective uncontrolled Chinese studies are showing clinical & even mortality benefit from tocilizumab, but as usual, wait for the RCT before jumping to conclusions. (they're enrolling now!)
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Replying to @s_r_constantin
management of cytokine release syndrome as an AE of CAR T therapy is basically routine now, even though it’s an ICU side effect; toci in this context isn’t all that arcane
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