COVID-19: Major study shows dexamethasone improves mortality among ventilated patients

The use of corticosteroids in systemic inflammatory response syndrome (SIRS) and multiple organ dysfunction syndrome (MODS) isn’t new, so it isn’t surprising that treatment of critically ill COVID-19 patients in the ICU has increasingly involved dexamethasone. Nevertheless, the first major results showing improvement in survival among ventilated COVID-19 patients given dexamethasone comes as very welcome…

“Conversation is the essence of palliative care”

A recent episode of Scott Weingart’s excellent EMCrit podcast featured a thoughtful discussion with Kei Ouchi, MD, on one of the most important aspects of emergency medicine and critical care; conservations regarding end-of-life care. The focus here is on rapid code status conversation. The podcast page offers a slew of useful links, and references the…

A Theoretical Model of the Pathophysiology of COVID-19

The latest episode of the EmCrit podcast features a discussion between Scott Weingart and Farid Jalali on the pathophysiology of COVID-19. Dr. Jalali’s wide-ranging insights on this complex, dynamic disease make this an absolute must-listen. EMCrit Wee – A Theoretical Model of the Pathophysiology of COVID-19 with Farid Jalali (Not a Single Thing Verified–Pure Musings)…

Sara Crager on right heart failure

Although I’ve been a religiously devoted listener of Scott Weingart’s EMCrit podcast for over five years, I haven’t previously shared an episode here on the blog. EMCrit recently featured a grand rounds lecture from Sara Crager on right heart failure that’s among the best lectures I’ve heard. Dr. Crager brilliantly distills complex physiology into a…

Worth reading: Less is more in intensive care

Catherine Auriemma et al. writing in Intensive Care Medicine: “The notion that ‘less is (or may be) more’ in intensive care medicine has been contemplated by experts for decades. However, not until Kox and Pickkers’ review in 2013 had there been careful consideration of the evidence supporting this theory.1 Their thought-provoking article focused specifically on…

Worth reading: The Case for Waking

Poetry and medicine, from Janis Lou Harrington in JAMA: https://jamanetwork.com/journals/jama/article-abstract/2757230 The Case for Waking “I. Beside my husband’s ICU bed, I plead my case for waking, hold my palm flat as a bible, place his warm hand on mine. His face inscrutable beneath a bandage wreath, he breathes on his own, his heart pumps, his…

COVID-19: Have high hospitalization rates made things worse?

While the 2002-2004 SARS coronavirus typically led to more severe clinical presentation than seen with COVID-19 (14-20% of patients required ventilatory support, and the case fatality rate was 9.2% compared to 4.1% and 5.6% respectively for COVID-19),1 this actually contributed to effective containment of the outbreak. High rates of nosocomial transmission and severity of presentation…

Worth reading: Communicating ICU Prognosis

A randomized trial published today in JAMA Network Open, with the useful visual abstract below. TL;DR: Participants who viewed videos using indirect or redirection language perceived the physician to be more optimistic than those who viewed a video of the physician answering the question directly. This is troubling because it suggests that that the families…