COVID-19: High Flow Nasal Cannula and Health Care Worker Infections

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High flow oxygen modalities have been restricted in some institutions due to concern for transmission to health care workers. Endotracheal intubation is one of the most aerosol generating procedures, but the exact risk associated with high flow nasal cannula (HFNC) and non-invasive ventilation is unknown. A 2012 meta-analysis reports on a single study that reported on high flow oxygen, but didn’t provide a definition for this.

We review a study (Westafer et al) that describes trends in health care worker infections at an institution before and after implementation of a protocol that increased use of high flow nasal cannula during the COVID-19 pandemic.

Steroids in COVID-19

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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. This episode was recorded September 3, 2020.

We have previously covered the RECOVERY trial’s reporting of the use of dexamethasone in hospitalized patients with COVID-19. In the wake of those results, several ongoing trials of steroids in COVID-19 were halted, due to concerns about loss of equipoise. Three of these trials were published in JAMA on September 2, 2020 in conjunction with a meta-analysis from the WHO REACT working group.

COVID-19: Convalescent Plasma Update

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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. This episode was recorded August 24, 2020.

Convalescent plasma has been a potential therapy for COVID-19. We covered the basics in this post, an RCT (Li et al) in this post. Here we discuss the US experience to date, which, despite detailing >35,000 patients who received plasma, did not randomize patients.

COVIDcast: Remdesivir vs Standard of Care

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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. This episode was recorded August 23, 2020.

Remdesivir, an inhibitor of viral RNA-dependent RNA polymerase, has been investigated for COVID-19. We have previously covered the initial uncontrolled report, the ACTT-1 trial, and a trial of 5-days vs 10 days of remdesivir which showed no difference. Here we have another trial by Spinnner et al in JAMA 2020.

Stop Giving Lidocaine in “GI Cocktails”

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We are trialing a new series of quick literature reviews. Let us know what you think

“GI cocktails” are commonly used in the Emergency Department for epigastric discomfort, but the evidence behind “cocktail” components is lacking and while lidocaine is commonly used, a trial by Berman et al found no benefit (versus a prior RCT in 1990 with high risk of bias).

In this episode we review a new trial by Warren et al on antacids versus antacids with lidocaine for epigastric pain and dyspepsia

COVID-19: Hydroxychloroquine [RECOVERY trial]

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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. This episode was recorded June 22, 2020

We’ve been looking at a treatment for severe COVID-19 and this massive trial from the United Kingdom, the RECOVERY trial published a pre-print of the results from the hydroxychloroquine arm (previously they published their promising results on dexamethasone). Note: these results are preliminary and have not been peer-reviewed

Hornby et al. [pre-print] supplement

COVID-19: Dexamethasone [RECOVERY trial]

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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. This episode was recorded June 22, 2020

We’ve been looking at a treatment for severe COVID-19 and this massive trial from the United Kingdom, the RECOVERY trial [protocol], published a pre-print of the results of the dexamethasone portion of the trial. Note: these results are preliminary and have not been peer reviewed

Hornby et al [pre-print]