Anesthesiology
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COVID-19 causes hypercoagulability, but the association between coagulopathy and hypoxemia in critically ill patients has not been thoroughly explored. This study hypothesized that severity of coagulopathy would be associated with acute respiratory distress syndrome severity, major thrombotic events, and mortality in patients requiring intensive care unit-level care. ⋯ Increased inflammatory and procoagulant markers such as plasminogen activator inhibitor 1, microparticle-bound tissue factor, and von Willebrand factor levels are associated with severe hypoxemia and major thrombotic events, implicating fibrinolytic suppression in the microcirculatory system and subsequent micro- and macrovascular thrombosis in severe COVID-19.
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Randomized Controlled Trial
Combination therapy of high-flow nasal cannula and upper body elevation for postoperative sleep disordered breathing; randomized cross-over trial.
The low acceptance rate of continuous positive airway pressure therapy in postoperative patients with untreated obstructive sleep apnea (OSA) indicates the necessity for development of an alternative postoperative airway management strategy. The authors considered whether the combination of high-flow nasal cannula and upper-body elevation could improve postoperative OSA. ⋯ The combination of high-flow nasal cannula and upper-body elevation reduced OSA severity and nocturnal hypoxemia, suggesting a role for it as an alternate postoperative airway management strategy.
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Editorial Comment
Mechanical Power: Correlate or Cause of Ventilator-induced Lung Injury?
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The first quantification of neural discharge from the carotid body of cats in response to hypoxia, hypercapnic acidosis, and their combination discovered a strong potentiating effect of hypoxia and hypercapnic acidosis combined as compared to either alone. This paper was the start of a research journey that eventually examined the regulation of blood and cerebrospinal pH by peripheral and central chemoreceptors in the setting of systemic acid-base alterations. This research focus was the result of the author's personal fascination with mountains and human adaptation to high altitude-an interest that led to his own ascent of Mount Everest in 1963. The inherent uncertainty and challenge involved with climbing high mountains has served as a metaphor and inspiration for his life, including his career in academic medicine.
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Editorial Comment
Hypoxia and Hypercoagulability in COVID-19: Chicken or the Egg?