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Let’s read an article a month – August 2020

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Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great piece under the categories of special communication and clinical review. The objective of this paper is to “formulate a consensus statement of recommendations on determination of BD/DNC based on review of the literature and expert opinion of a large multidisciplinary, international panel” p. E1. A common abbreviation used in this article and this post is Brain Death (BD) and Death by Neurologic Criteria (DNC).

Determination of Brain Death/Death by Neurologic Criteria The World Brain Death Project

by David M. Greer, MD, MA1; Sam D. Shemie, MD2,3; Ariane Lewis, MD4; et al .

Link to the article: https://ja.ma/2PlPK5p

Reasons you may find this article interesting:

  • It involves many experts from various organizations. The list of these organizations can be found under Methods on page E2 (World Federation of Intensive and Critical Care, World Federation of Pediatric Intensive and Critical Care Societies, World Federation of Neurology, World Federation of Neurosurgery, and the World Federation of Critical Care Nurses).
  • There are notes for the adult and Pediatric/Neonatal populations.
  • The list of ideas and recommendations are nicely organized under their own headings:
    • The Concept of BD/DNC (p. E4),
    • Minimal Clinical Criteria for Determination of BD/DNC (p. E5),
    • Apnea Testing (p. E6),
    • Number of Examinations (p. E8),
    • Pediatric/Neonatal BD/DNC (p.E9),
    • Determination of BD/DNC in Patients Requiring Extracorporeal Membrane Oxygenation (p. E11),
    • Determination of BD/DNC After Treatment With Targeted Temperature Management (p. E11),
    • Documentation of BD/DNC (p. E12),
    • Qualifications for and Education on Determination of BD/DNC (p. E13),
    • Religion and BD/DNC: Managing Requests to Forgo a BD/DNC EValuation or Continue Somatic Support After BD/DNC (p. E15), and
    • BD/DNC and the Law (p. E16).
  • The authors address sensitive issues such as religion and law with detailed notes in the supplementary online documents 12 and 13 that are found on JAMA’s website ( or the following links: Religion and Law).

As I was reading this article, I was reminded of the practices I was taught at my main training hospital. Many of the items on the protocol, from 6 years ago, meet the list mentioned in this article. Working in the greater Toronto area, with its great diversity, reminds me of one of the complexities involved in the determination and the care of BD/DNC patients.

Happy learning and reading!

Farzad Refahi
August 6th 2020

https://respiratory.blog/let’s-read-an-article-a-month-august-2020/

Let’s read an article a month – July, 2020

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Screenshot of the first page of the printed article

Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great case-study in Canadian Journal of Respiratory Therapy (CJRT) .

Helmet CPAP revisited in COVID-19 pneumonia: A case series

by Aniket S. Rali, Christopher Howard, Rachel Miller, Christopher K. Morgan, Dennis Mejia, John Sabo, James P. Herlihy, Sunjay R. Devarajan
Published online on July 21, 2020.
https://www.cjrt.ca/wp-content/uploads/cjrt-2020-019.pdf

Reasons you may find this article interesting:

  • It’s a nice and quick read.
  • We all have seen photos of Helmet CPAPs being used in Italy. If you haven’t had the chance to look into them, this article will provide you will some useful information!
  • It is published in a Canadian Journal so why not! Side note, the authors’ affiliations is in Houston, TX, USA.
  • The authors talk about three cases with various backgrounds and outcomes (pp. 1-2).
  • The authors discuss the benefits and shortcoming of Helmet CPAPs (e.g. “prevention of functional and neuromuscular complications”, minimization of aerosolization, requirement for high flow rates, difficulty with resting the head, and other details pp. 2-3).

This article shares the experience on only 3 cases, so set your expectations accordingly when picking up this article.

Happy learning and reading!

Farzad Refahi
July 24 2020
https://respiratory.blog/lets-read-an-article-a-month-july-2020/

PFT Re-opening

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The joint statement from the Canadian Thoracic Society and Canadian Society of Respiratory Therapists on the re-opening of PFT labs during the pandemic is released.

I had the pleasure of working and learning from all the experts in this team!

A special thank you to Carolyn McCoy, Sanja Stanojevic, and Micah Kooperberg for their leadership!
The article can be found both on CSRT and CTS websites:

CSRT: https://www.csrt.com/wp-content/uploads/CTS_CSRT_COVID_PFT_Final-July12_2020.pdf

CTS: https://cts-sct.ca/wp-content/uploads/2020/07/CTS_CSRT_COVID_PFT_Final-July12_2020.pdf

This statement was released on July 12th, 2020, and was based on the available information and data at that time! Please follow the guidelines provided by your organization’s experts and infection control team.

Farzad Refahi
July 13, 2020
https://respiratory.blog/pft-reopening/

Let’s read an article a month– June 2020

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Every month I try to read an open-access article. After reading the article, I share the title and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great article on June 20th, 2020. I spent a few days with it, and now I share it with you.

Predictors of progression in systemic sclerosis patients with interstitial lung disease

  Oliver Distler, Shervin Assassi, Vincent Cottin, Maurizio Cutolo, Sonye

  K. Danoff, Christopher P. Denton, Jörg H.W. Distler, Anna-Maria

  Hoffmann-Vold, Sindhu R. Johnson, Ulf Müller Ladner, Vanessa Smith,

  Elizabeth R. Volkmann and Toby M. Maher

  Eur Respir J 2020 55:1902026; published ahead of print 2020,

  doi:10.1183/13993003.02026-2019 OPEN ACCESS

https://erj.ersjournals.com/content/erj/55/5/1902026.full.pdf

Top 3 reasons why I enjoyed reading this article:

-A well-written review of key pathways implicated in systemic sclerosis-associated interstitial lung disease (pp2-4 ). Inflammatory pathways are complex and while I enjoy reviewing them, I never tend to be able to memorize them. There is also a nice diagram that goes along with the description (i.e. Figure 1 on page 3).  

-An insider and expert view of the challenges involved with the disease diagnosis. When it comes to interstitial lung disease, there is so much for me to read and learn about. I am involved with the Pulmonary Diagnostic side of respiratory care, and mostly I see patients with confirmed diagnosis of interstitial lung disease (usually in the later stages). Occasionally I do see patients who have some indications in an imaging test, CXR or Chest-CT, and are visiting the PFT lab for additional information. “One potential barrier to diagnosis a lack of awareness within primary care of SSc, which can lead to late referrals” (p.5). 

-If you are involved with pulmonary diagnostics, you will enjoy this article as there are references to lung function values (with some references to 6MWTs) (found on pp 7-8).

Happy Learning!

Farzad Refahi
June 25, 2020

http://respiratory.blog/let’s-read-an-article-a-month–june-2020/

Let’s read an article a month – May 30, 2020

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Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay up to date, and continue to grow.

This month I found a great editorial post on May 15th, 2020. I spent a few days with it, and now I share it with you.

Will children reveal their secret? The coronavirus dilemma
Luca Cristiani, Enrica Mancino, Luigi Matera, Raffaella Nenna, Alessandra Pierangeli, Carolina Scagnolari, Fabio Midulla
European Respiratory Journal 2020
55: 2000749; DOI: 10.1183/13993003.00749-2020 https://erj.ersjournals.com/content/55/4/2000749

You will be presented by suggestions, ideas and theories such as high angiotensin-converting enzyme 2 (ACE2) receptor concentration, innate immune response as both protective and a destructive mechanism, and constitutional elevated lymphocytes.

Happy Learning!

Farzad Refahi
http://respiratory.blog/lets-read-an-article-a-month-may-30-2020/