James
@lordofthelungs.bsky.social
Pulm Ccm , ILD and PAH, addicted to 10a gardening
I pretend I'm not surprised when it works out like that.
January 4, 2025 at 12:26 PM
I pretend I'm not surprised when it works out like that.
I hear you. I hobble around until I get my orthotic indoor sandals on so my flat feet and plantar fasciitis don't keep me from packing lunches every morning.
December 22, 2024 at 3:22 PM
I hear you. I hobble around until I get my orthotic indoor sandals on so my flat feet and plantar fasciitis don't keep me from packing lunches every morning.
Super interesting paper and study. Did we need the placebo group? Would pre-post have been enough? Just wondering since I would feel bad about keeping my IPF patient off of nintedanib for three months.
December 22, 2024 at 4:59 AM
Super interesting paper and study. Did we need the placebo group? Would pre-post have been enough? Just wondering since I would feel bad about keeping my IPF patient off of nintedanib for three months.
I love changing to odd numbers and seeing how long until the RT can't resist the urge to change back to evens
December 19, 2024 at 11:18 PM
I love changing to odd numbers and seeing how long until the RT can't resist the urge to change back to evens
I would think that PRVC is more problematic if used in a non-invasive setting. The awake patient with leaking around the mask could throw off the algorithm and result in too much variation in volume wouldn't it?
December 16, 2024 at 11:45 AM
I would think that PRVC is more problematic if used in a non-invasive setting. The awake patient with leaking around the mask could throw off the algorithm and result in too much variation in volume wouldn't it?
This comes up in pulm clinic as part of the work up in dyspnea consults as well, and I still don't know if non anemic iron deficiency can be a cause for dyspnea. I think it probably can, but I'm reminded that I don't understand the human body on a daily basis. It seems impossible to study
December 16, 2024 at 11:02 AM
This comes up in pulm clinic as part of the work up in dyspnea consults as well, and I still don't know if non anemic iron deficiency can be a cause for dyspnea. I think it probably can, but I'm reminded that I don't understand the human body on a daily basis. It seems impossible to study
I've never seen a noninvasive vent that can do PRVC. Do you know what device you have at your place?
December 16, 2024 at 10:46 AM
I've never seen a noninvasive vent that can do PRVC. Do you know what device you have at your place?
I feel like you and I would bore everyone on rounds. For just hypoxia, there's no role for inhaled vasodilators for me. either overcome with the vent or they go on ecmo.
December 16, 2024 at 12:22 AM
I feel like you and I would bore everyone on rounds. For just hypoxia, there's no role for inhaled vasodilators for me. either overcome with the vent or they go on ecmo.
I'd also add that I'm not sold on a benefit from matching intrinsic peep. Doesn't seem to help. You also risk increasing end expiratory volume, which will worsen hyperinflation.
December 16, 2024 at 12:17 AM
I'd also add that I'm not sold on a benefit from matching intrinsic peep. Doesn't seem to help. You also risk increasing end expiratory volume, which will worsen hyperinflation.
I'm a pulmonologist, and you did an amazing job here. To look like a boss when bipap is failing, just say change to AVAPS and walk away.
here.to
December 16, 2024 at 12:15 AM
I'm a pulmonologist, and you did an amazing job here. To look like a boss when bipap is failing, just say change to AVAPS and walk away.
That's my kind of hobby
December 11, 2024 at 11:36 AM
That's my kind of hobby
That's awesome. I was thinking of doing that with this little dwarf pomegranate I have, but it looks like an intense hobby
December 11, 2024 at 10:40 AM
That's awesome. I was thinking of doing that with this little dwarf pomegranate I have, but it looks like an intense hobby
Would be interesting to see a similar study on patients who have had pericardiotomy
December 4, 2024 at 11:55 PM
Would be interesting to see a similar study on patients who have had pericardiotomy
That's what I was taught as a reason to push for rhythm control in PAH patients in Afib. Also explains why these patients can crash so quickly when they flip into a fib and the dangers of inotropes. This is more pulmonary hypertension than critical care, but I think the concept remains.
December 1, 2024 at 10:44 PM
That's what I was taught as a reason to push for rhythm control in PAH patients in Afib. Also explains why these patients can crash so quickly when they flip into a fib and the dangers of inotropes. This is more pulmonary hypertension than critical care, but I think the concept remains.
I have a lot of veterans in pulm clinic. They don't get nearly enough benefits. This article is garbage
December 1, 2024 at 8:39 PM
I have a lot of veterans in pulm clinic. They don't get nearly enough benefits. This article is garbage
So agreed. Multicenter randomized control trial looks like it's in the works with our institutions. I'll get the protocol drafted and send it to you both.
First obstacle will just be to get people to care about the poor right ventricle
First obstacle will just be to get people to care about the poor right ventricle
December 1, 2024 at 3:47 PM
So agreed. Multicenter randomized control trial looks like it's in the works with our institutions. I'll get the protocol drafted and send it to you both.
First obstacle will just be to get people to care about the poor right ventricle
First obstacle will just be to get people to care about the poor right ventricle
Totally reasonable and I recognize that some folks will look at you cross eyed when ordering treprostinil. I think the key is having an objective way to measure if there was an improvement. If not, do something different.
December 1, 2024 at 3:46 PM
Totally reasonable and I recognize that some folks will look at you cross eyed when ordering treprostinil. I think the key is having an objective way to measure if there was an improvement. If not, do something different.
A stunned RV with normal pulmonary vascular compliance maybe. But not enough after load reduction to help when after load is the main problem.
I often cite this paper to highlight the dangers of Afib in RV failure. They're much more reliant on atrial kick. pubmed.ncbi.nlm.nih.gov/27683609/
I often cite this paper to highlight the dangers of Afib in RV failure. They're much more reliant on atrial kick. pubmed.ncbi.nlm.nih.gov/27683609/
Assessment of the physiologic contribution of right atrial function to total right heart function in patients with and without pulmonary arterial hypertension - PubMed
Total right heart function requires normal function of both the right ventricle and the right atrium. However, the degree to which right atrial (RA) function and right ventricular (RV) function each c...
pubmed.ncbi.nlm.nih.gov
December 1, 2024 at 3:40 PM
A stunned RV with normal pulmonary vascular compliance maybe. But not enough after load reduction to help when after load is the main problem.
I often cite this paper to highlight the dangers of Afib in RV failure. They're much more reliant on atrial kick. pubmed.ncbi.nlm.nih.gov/27683609/
I often cite this paper to highlight the dangers of Afib in RV failure. They're much more reliant on atrial kick. pubmed.ncbi.nlm.nih.gov/27683609/
I know a lot of people like milrinone in RV failure, but it doesn't work when the PVR is high. And the risk of arrhythmia is particularly dangerous with a weak RV
December 1, 2024 at 3:35 PM
I know a lot of people like milrinone in RV failure, but it doesn't work when the PVR is high. And the risk of arrhythmia is particularly dangerous with a weak RV
I've given up on inhaled because I've never seen objective evidence of improvement like this when ARDS is this bad. I think there isn't enough ventilation
December 1, 2024 at 3:26 PM
I've given up on inhaled because I've never seen objective evidence of improvement like this when ARDS is this bad. I think there isn't enough ventilation