May 12, 2020

Background: Current management of COVID-19 focuses on supportive care as there are yet to be robust, data driven treatments. To date, there has barely been a glimmer of hope based on published evidence, as most studies are either poor quality or demonstrate “negative” results.  Two more trials have now been published looking at some new options as potential candidates.

May 11, 2020

“You’re in the emergency department, you have a patient who EMS has brought in from a nursing home…who’s excited? Right, nobody is. And they are brought in for a chief complaint of altered mental status. So they’re concerned about sepsis. This is your initial set of vital signs: febrile, tachycardic, hypotensive. And you’re looking at the patient and you’re looking at their Foley and it looks like somebody put oatmeal into it. You know for a fact that the probability is that they have a urinary tract infection is pretty high. So the next question is: do you do what you normally do, but add steroids?”

May 8, 2020

Background: Although Helmet CPAP is not something commonly used in the US, I think its nice to know what other potential options there are to help patients in the midst of a COVID-19 pandemic. Hypoxemic acute respiratory failure (hARF) is a well-known complication that can occur in patients with pneumonia.  This has a high morbidity and mortality associated with it.  An intermediary step prior to intubation is the use of noninvasive positive pressure ventilation (NIPPV) to stave off intubation. A more important question is does NIPPV in patients with pneumonia and hARF improve clinical outcomes? There have been no randomized clinical trials that have evaluated the clinical efficacy of helmet CPAP in patients with pneumonia suffering from hARF to date Helmet CPAP has also gained recent attention as an oxygenation tool for COVID19 pneumonia. The authors of this trial wanted to compare helmet CPAP vs oxygen therapy delivered by Venturi mask to reduce the proportion of patients requiring ETI in hARF due to pneumonia.