Publications by authors named "Yonatan Y Greenstein"
Article Synopsis
- Therapeutic-dose heparin may reduce the need for organ support in noncritically ill COVID-19 patients, but its effect on long-term symptoms and quality of life (QOL) is unclear.
- The ACTIV-4a trial randomized 727 hospitalized COVID-19 patients to either therapeutic or prophylactic heparin, with a focus on their symptoms and QOL at a 90-day follow-up using the EQ-5D-5L survey.
- Results indicated that about 50% experienced at least one symptom post-hospitalization, with therapeutic heparin linked to reduced physical impairment, but no significant differences in overall symptoms or QOL scores between the heparin treatment groups.
Article Synopsis
- - Intraosseous (IO) catheters are used for quick fluid and medication delivery in critically ill patients, but misplacement can lead to serious complications such as limb necrosis.
- - A study compared the effectiveness of traditional methods for confirming IO catheter placement to a new pressure waveform analysis method, which identified misplacements more accurately.
- - Results showed that the new pressure waveform technique had a higher accuracy and reliability in detecting improperly placed IO catheters compared to standard and power Doppler ultrasound methods, potentially enhancing patient safety.
The use of point-of-care ultrasonography in the intensive care unit has been rapidly advancing over the past 20 years. This review will provide a broad overview of the discipline spanning lung ultrasonography to advanced critical care echocardiography. It will highlight new research that questions the utility of the inferior vena cava for determining volume responsiveness and will introduce the reader to cutting-edge technology including artificial intelligence, which is likely to revolutionize ultrasound teaching and image interpretation, increasing the reach of this modality for the frontline clinician.
View Article and Find Full Text PDFTherapeutic Anticoagulation with Heparin in Critically Ill Patients with Covid-19.
N Engl J Med
August 2021
Article Synopsis
- A clinical trial investigated whether therapeutic-dose anticoagulation could improve outcomes for critically ill patients with severe Covid-19 compared to standard thromboprophylaxis.
- The study found no significant difference in organ support-free days between the two groups, with the anticoagulation group showing a median of 1 day compared to 4 days for the usual-care group.
- The trial was halted due to a high probability of futility, with similar hospital discharge survival rates and a slightly higher occurrence of major bleeding in the anticoagulation group.
Therapeutic Anticoagulation with Heparin in Noncritically Ill Patients with Covid-19.
N Engl J Med
August 2021
Background: Thrombosis and inflammation may contribute to the risk of death and complications among patients with coronavirus disease 2019 (Covid-19). We hypothesized that therapeutic-dose anticoagulation may improve outcomes in noncritically ill patients who are hospitalized with Covid-19.
Methods: In this open-label, adaptive, multiplatform, controlled trial, we randomly assigned patients who were hospitalized with Covid-19 and who were not critically ill (which was defined as an absence of critical care-level organ support at enrollment) to receive pragmatically defined regimens of either therapeutic-dose anticoagulation with heparin or usual-care pharmacologic thromboprophylaxis.
Clarification of Critical Care Ultrasonography Certification.
J Cardiothorac Vasc Anesth
October 2018
Article Synopsis
- Assessing left ventricular diastolic function is crucial in advanced critical care echocardiography, particularly for patients in a critical care setting.
- Traditional methods used in cardiology may be challenging to implement in the ICU, necessitating alternative approaches.
- The article discusses both standard cardiology methods and a simplified approach for measuring diastolic function relevant to intensivists.
Article Synopsis
- Flexible bronchoscopy (FB) in mechanically ventilated patients can lead to increased airway resistance, and the study aimed to assess changes in end-expiratory lung volume (EELV) while limiting tidal volume (VT).
- Out of 16 intubated subjects studied, FB insertion decreased EELV in 64% of cases, and suctioning further decreased EELV in 76% of cases, with no significant changes in respiratory mechanics noted.
- The conclusions suggest that there was no significant increase in EELV during FB, and suctioning should be minimized in at-risk patients to avoid adverse effects on lung recruitment.
Article Synopsis
- - A national-level, simulation-based 3-day CCUS training program was evaluated for its effectiveness, consisting of lectures, image interpretation, and hands-on training with live models for 363 participants.
- - Results showed significant improvements in test scores: pretest average was 57%, while posttest average rose to 90%, indicating enhanced cognitive and image interpretation skills.
- - Younger learners (20-39 years) performed better in both written and hands-on tests compared to older participants (≥40 years), suggesting age-related differences in learning outcomes during the course.
Article Synopsis
- Current guidelines support the use of intraosseous access when IV access is difficult, with pediatric studies showing it is generally safe, but adult studies are limited.
- A case report of vasopressor extravasation during intraosseous access led to successful management through specific pharmacological treatments.
- A systematic review of adult intraosseous access found a 91% success rate for tibia and humeral insertions but noted serious complications in some cases, indicating that while useful, there are risks involved.
Introduction: Goal-directed echocardiography (GDE) is used to answer specific clinical questions that provide invaluable information to physicians managing a hemodynamically unstable patient. We studied perception and ability of house staff previously trained in GDE to accurately diagnose common causes of cardiac arrest during simulated advanced cardiac life support (ACLS); we compared their results with those of expert echocardiographers.
Methods: Eleven pulmonary and critical care medicine fellows, 7 emergency medicine residents, and 5 cardiologists board certified in echocardiography were enrolled.