COVID-19: Is it ARDS? HAPE? Hemoglobinopathy?

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We are bringing you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes. Today we are joined by Dr. Rory Spiegel of EMNerd to discuss various theories and possible mechanisms for the clinical picture we see with severe COVID-19.

Gattinoni L, Coppola S, Cressoni M, Busana M, Chiumello D. Covid-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med. 2020; In press

Many people have been talking about the “hemoglobin hijacking” of COVID-19 but this is far from a certain theory and really only from a single computer simulation model.

It appears that hypoxic vasoconstriction is the most robust explanation at this time. This has led to some drawing parallels to high altitude pulmonary edema (HAPE).

COVID-19: The ROX index for predicting HFNC failure

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Today we are joined by Dr. Rory Spiegel of EMNerd to discuss the ROX index which has been proposed as a means of predicting who might fail high flow nasal cannula, and has been proposed as a part of some pathways for COVID-19 respiratory management

Roca O, Messika J, Caralt B, et al. Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index. J Crit Care. 2016;35:200-5.

Roca O, Caralt B, Messika J, et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High-Flow Therapy. Am J Respir Crit Care Med. 2019;199(11):1368-1376

Check out Brief19 for COVID-19 related policy updates

COVID-19: High Flow Nasal Cannula (Wang et al)

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Wang et al. The experience of high-fow nasal cannula
in hospitalized patients with 2019 novel coronavirus-infected pneumonia in two hospitals of Chongqing, ChinaAnn Intensive Care. 2020 10(37)

COVID-19: Hypercoagulability?

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We are going to try to bring you near-daily updates on COVID-19. There is a firehose of information and most of us are too busy to read and digest it all. Note: If you are listening to these more than a few days in the future, please beware that information may have changed and check subsequent episodes.

Reports of venous thromboembolism and hypercoagulability are emerging (Xie et al), which may make sense (inflammation/stigmata of critical illness/etc).