April 30, 2020

Background: Currently, there are no approved medications for the treatment of COVID-19, but,  there are many investigational agents that have shown antiviral activity against SARS-CoV-2 in vitro.  Unfortunately in vitro studies do not always extrapolate to clinical care  In vitro studies of remdesivir demonstrate inhibition of  human and animal coronaviruses tested including SARS-CoV-2.  However, the clinical and antiviral efficacy of remdesivir in COVID-19 remains to be established. The title of this post is, "two more trials just published on Remdesivir," but in reality it is 1.5 trials as we don't have the full release of the 2nd trial (see discussion).

April 28, 2020

Early reports have shown that COVID-19 is most likely causing a hypercoagulable state, however the prevalence of acute VTE and exactly how to treat it is an evolving area.  Limited data suggest pulmonary microvascular thrombosis may play a role in progressive respiratory failure.  However, most evidence is limited to small retrospective trials.  As we wait for more evidence, clinical decisions have to made at the bedside and decisions about pharmacological prophylaxis are starting to emerge.  In this episode I sit down with a special guest that is new to REBEL Cast to talk about the dilemmas involving COVID-19 and thrombosis.

April 26, 2020

Background: Awake proning, or having patients lie on their stomachs, can help oxygenation by helping to recruit posterior portions of the lungs and by helping with perfusion to oxygenated lung segments. The literature around proning centers on intubated patients with adult respiratory distress syndrome in the ICU. However, there are increasing recommendations from front line clinicians and experts about the benefits of proning hypoxemic COVID19 patients who are awake in an effort to improve oxygenation and stave off intubation. While there may be physiologic reasoning, anecdotal experience and application of data from intubated patients, there is an absence of data specifically on COVID19 patients and proning. Fortunately, we now have some literature to look at:

April 24, 2020

In this episode of REBEL Cast,I sit down with Richard Levitan and talk about some ideas from his experience in New York, where he spent 10 days during the surge of the COVID-19 pandemic. And the lessons he took away were, I think, invaluable for how we’re going to manage these patients going forward.

April 21, 2020

Introduction: N95 filtering facepiece respirators (FFP, from here out referred to as N95) are designed to filter out 95% of airborne particles and are intended for single use. During the COVID19 pandemic, N95s are in short supply forcing us to consider reuse of the devices in order to maintain protection in clinical environments. However, there is only limited data on safe decontamination and reuse practices. As of the writing of this post, it is unclear when adequate supplies of N95s will be available and numerous hospitals have already started reuse protocols. Here, we review the current literature and recommendations. It’s important to recognize that both ability to filter and fit of the N95 are important in terms of use and reuse. Of note, residual virus may be present after any of these methods but, amounts remaining should not produce clinical infection.

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