Friday

Ventilator management of bronchopleural fistula

A 47-year-old man with COVID-19 pneumonia complicated by severe acute respiratory distress syndrome (ARDS) suddenly desaturates. Point-of-care ultrasound and chest x-ray are consistent with pneumothorax. After placement of a pigtail catheter, hypoxemia persists and a large continuous air leak is present. What are the next steps in management of a suspected bronchopleural fistula? 

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Arterial Lines

You’re working in the ICU overnight and are having difficulty obtaining a blood pressure for a patient that was just transferred to your facility for septic shock secondary to pneumonia. You make the decision to place an arterial line. You place the line sterilely using seldinger technique and connect it to the monitor. Your hard work paid off and you are rewarded with a waveform.

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Mechanical ventilation strategies in status asthmaticus

Less than 5 percent of patients hospitalized for acute asthma exacerbation will require mechanical ventilatory support. However, ventilator management in status asthmaticus is unique and the impact of increased airway resistance on ventilation strategies must be understood to avoid life-threatening complications like severe acidosis, barotrauma and hypotension. 

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Should remdesivir be utilized for severe COVID-19?

As the number of COVID-19 cases rises drastically and the global pandemic continues to change life as we know it, we are all hoping for news of effective treatment. Approximately 15 percent of patients infected with SARS-CoV-2 develop pneumonia requiring supplemental oxygen and an additional 5 percent progress to critical illness and acute hypoxemic respiratory failure. Although numerous drugs have been investigated, only dexamethasone has demonstrated improved survival in patients hospitalized with COVID-19 in a randomized controlled trial design. We now have data from 3 randomized controlled trials to guide the use of remdesivir for severe COVID-19.  

 

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