TeleNeuroICU: Expanding the Reach of Subspecialty Neurocritical Care.

Telemedicine is a rapidly growing field of medicine due to a combination of high-speed global telecommunication systems and accessibility of small, fast mobile computing platforms with bidirectional audiovisual camera capabilities. Teleneurology is a subset of telemedicine. TeleNeuroICU, one form of teleneurology, is the practice of virtually consulting on patients in the ICU setting with neurological and neurosurgical conditions. Given the current and future shortage of neurologists and neurointensivists, there is a high demand for TeleNeuroICU services around the globe and this is expected to increase in the future. This review summarizes the state of the art around the TeleNeuroICU practice for practitioners in the field, emerging research in this area, and new technologies and integrations that enhance the value of TeleNeuroICU to health care systems.

COVID-19 infodemics: how social media shared information rapidly to global healthcare teams

INTRODUCTION: The global coronavirus disease 2019 (COVID-19) pandemic created a considerable need for rapid knowledge transmission, but most traditional peer-reviewed journals are struggling to keep up. Other modes of sharing information, such as social media and preprint publications have rapidly become a source of information. While some academicians might argue that these media lack the rigor of a peer-reviewed process, others argue that the current journal submission process is too slow and laborious and delays the free and open exchange of ideas and potentially useful information. METHODS: We measured the reach of social media posts related to the global coronavirus disease 2019 (COVID-19) pandemic, the number of times the posts were shared, the number of countries the posts reached, and the speed of dissemination. RESULTS: @CMichaelGibson tweeted regarding a comparison of different dyi materials from a University of Cambridge research article. This post with #macgyvercare was heavily retweeted and within 3 days the post had been shared by people in 53 countries, and within a week, 79 countries. During this time, the US and the CDC had not commented on the utility of masks for the public or on a universal need for health care workers to wear masks except during procedures with a high risk of aerosolization. Secondly a post on a social media platform tagged #aerosolbox described an improvised, low-cost, aerosol box to help give health care workers additional protection against the novel coronavirus when intubating was shared. In 12 days the idea that was initially posted on Facebook subsequently spread through news media and social media to 6 continents was modified and implemented in hospitals around the globe, and was ultimately described in a leading medical journal. Also, within the same 12-day span, information about #aerosolbox was shared publicly over 26,400 times on social media by people in 110 countries. CONCLUSIONS: Social media is a powerful tool for the dissemination of digital health information. As seen the information traveled far and fast during the COVID-19 pandemic and underwent considerable online feedback while spreading, often transforming into news articles and traditional academic peer-reviewed publication.

Tele-monitoring non-critically ill COVID-19 patients: An advanced practice provider-led initiative

INTRODUCTION: The COVID-19 pandemic has required adaptation and implementation of innovative healthcare practices, including patient triage and limiting staff exposure. Early recognition of deteriorating patients is an imperative step in preventing adverse events, improving outcomes, and limiting unnecessary exposures. Here we describe a critical care medicine (CCM) advanced practice provider (APP) led initiative to implement remote monitoring of non-critically ill COVID-19 patients for signs of deterioration, prompt intervention, and rapid transfer to the intensive care unit (ICU). METHODS: Every admitted COVID-19 patient received an initial remote telemedicine consult by a CCM APP. Patients were then monitored via EMR review once per 12-hour shift for the following indicators: oxygen modality and flow, increase in oxygen requirements, sustained tachypnea, and hemodynamic instability (mean arterial pressure less than 65mmHg or arrhythmias). If signs of deterioration were noted, the APP would remotely reassess the patient, provide recommendations to the primary team, and/or transfer the patient to the ICU. The primary endpoint was avoidance of acute cardiopulmonary deterioration requiring aerosolgenerating procedures (AGPs) outside of the ICU. RESULTS: Over 65 days, there were 2204 total hospital admissions, of which 113 (5.1%) (86 PUIs and 27 SARSCoV- 2-positive) patients were followed by the CCM APPs. Early ICU transfer was initiated on 13 occasions (12 patients, 1 of which had 2 transfer occurrences). Of those transfers, 4 (30.8%) required intubation, 2 (15.4%) required non-invasive ventilation, and 5 (38.5%) required high flow nasal cannula, all of which occurred in negative pressure rooms within the ICU. Vasoactive support was initiated for 5 (38.5%) patients after transfer. Of the 2091 admitted patients not followed by CCM APPs, 9 (0.4%) experienced cardiopulmonary arrest outside of the ICU and 96 (4.6%) required rapid responses. Of the 113 monitored patients, 0 (0%) required rapid responses or experienced cardiopulmonary arrest or required an AGP outside of the ICU. CONCLUSIONS: An APP-led tele-monitoring program may potentially avoid unnecessary viral exposures, decrease the risk of performing emergent AGPs, optimize ICU bed elasticity, and potentially minimize preventable in-hospital mortality.

Endotheliitis, endothelin, and endothelin receptor blockers in COVID-19.

We summarize the role of endothelin as a potent vasoconstrictor, pro-inflammatory, pro-oxidative agent in the pathophysiologic effects and end-organ dysfunction of coronavirus disease 2019 (COVID-19). Endotheliitis is an under-recognized pathophysiologic process that causes various types of dysfunction in end organs, including heart, lung, kidney, and brain. Endothelin receptor blockers, such as bosentan and sitaxentan, can pave a path ahead in the realm of COVID-19 therapies. These agents have a potential role against COVID-19 and should be studied in research trials to determine their efficacy in treatment of this severe disease.

Platforms for Personalized Polytherapeutics Discovery in COVID-19.

The COVID-19 pandemic entered its third and most intense to date wave of infections in November 2020. This perspective article describes how combination therapies (polytherapeutics) are a needed focus for helping battle the severity of complications from SARS-CoV-2 infection. It outlines the types of systems that are needed for fast and efficient combinatorial assessment of therapeutic candidates. Proposed are micro-physiological systems using human iPSC as a format for tissue-specific modeling of infection, the use of gene-humanized zebrafish and C. elegans for combinatorial drug screens due to the animals being addressable in liquid multi-well formats, and the use of engineered pseudo-typing systems to safely model infection in the transgenic animals and engineered tissue systems.

Robotics in Simulated COVID-19 Patient Room for Health Care Worker Effector Tasks: Preliminary, Feasibility Experiments.

The coronavirus disease 2019 (COVID-19) pandemic has strained health care systems and personal protective equipment (PPE) supplies globally. We hypothesized that a collaborative robot system could perform health care worker effector tasks inside a simulated intensive care unit (ICU) patient room, which could theoretically reduce both PPE use and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) exposures. We planned a prospective proof-of-concept feasibility and design pilot study to test 5 discrete medical tasks in a simulated ICU room of a COVID-19 patient using a collaborative robot: push a button on intravenous pole machine when alert occurs for downstream occlusion, adjust ventilator knob, push button on ICU monitor to silence false alerts, increase oxygen flow on wall-mounted flow meter to allow the patient to walk to the bathroom and back (dial-up and dial-down oxygen flow), and push wall-mounted nurse call button. Feasibility was defined as task completion robotically. A training period of 45 minutes to 1 hour was needed to program the system de novo for each task. In less than 30 days, the team completed 5 simple effector task experiments robotically. Selected collaborative robotic effector tasks appear feasible in a simulated ICU room of the COVID-19 patient. Theoretically, this robotic approach could reduce PPE use and staff SARS-CoV-2 exposure. It requires future validation and health care worker learning similar to other ICU device training.

Three-tier stratification for CNS COVID-19 to help decide which patients should undergo lumbar puncture with CSF analysis: a case report and literature review.

The COVID-19 pandemic continues to overwhelm global healthcare systems. While the disease primarily causes pulmonary complications, reports of central nervous system (CNS) involvement have recently emerged ranging from encephalopathy to stroke. This raises a practical dilemma for clinicians as to when to pursue neuroimaging and lumbar tap with cerebrospinal fluid (CSF) analysis in COVID-19 patients with neurological symptoms. We present a case of an encephalopathic patient infected with SARS-CoV-2 with no pulmonary symptoms. We propose a three-tier risk stratification for CNS COVID-19 aiming to help clinicians to decide which patients should undergo CSF analysis. The neurological examination remains an integral component of screening and evaluating patients for COVID-19 considering the range of emerging CNS complications.