Background: On March 7, New York was declared in “State of Emergency”; all Emergency Room and hospital facilities in NYC were overwhelmed by the rapid and high influx of patients with COVID-19 infection. At least 20% of patients with criteria for hospitalization received mechanical ventilation, and the Mortality reached 80% in a time when the [...]

Background: Sepsis is one of the leading causes of admission to intensive care units (ICU), and it is one of the most expensive conditions treated in United State Hospitals accounting for $20.3 billion or 5.2% of total hospitalization cost. Idiopathic pulmonary fibrosis (IPF) is one of the leading causes of interstitial lung disease, with currently [...]

Background: ARDS incidence in patients with COVID-19 pneumonia varies from 15-42%; between 5-20% of patients with hospitalization criteria received mechanical ventilation (1-3). Prone positioning demonstrated mortality benefits for patients with Severe ARDS (sARDS) with lung injury, but its use in patient COVID-19 is not clear (4-6). ARDS protocol (ARDSp) is recommended by ATS and The [...]

Background: Venous thromboembolism, in particular, pulmonary embolism (PE), is a significant contributor to morbidity and mortality associated with COVID-19. In comparison to influenza, COVID-19 leads to a more pronounced hypercoagulable state secondary to endotheliopathy and hyperinflammatory state which results in the formation of venous and arterial thrombosis. Based on prior literature, patients with COVID-19 have [...]

Background: Provider continuity can improve many aspects of an inpatient stay however, there is a lack of data on whether it could affect mechanical ventilation weaning. During the COVID-19 pandemic, many patients required tracheostomies and mechanical ventilation. This study evaluated whether provider continuity could increase mechanical ventilation weaning outcomes in the inpatient setting. Methods: Data [...]

Background: Although novel oral anticoagulants (NOAC) have been proven as effective alternatives to warfarin in patients with atrial fibrillation, the effectiveness of NOACs in patients with artificial (bioprosthetic and mechanical) heart valves is not known. This systematic review and meta-analysis evaluates multiple clinical outcomes between warfarin and NOACs in patients with artificial heart valves. Methods: [...]

Background: Current national guidelines recommend using mechanical methods for venous thromboembolism (VTE) prophylaxis in hospitalized medical patients at elevated risk for thrombosis who have a contraindication to pharmacologic prophylaxis. Additionally, it is recommended to avoid the use of mechanical prophylaxis for patients who are at low risk for VTE. The Michigan Hospital Medicine Safety Consortium, [...]

Background: Perioperative management of anticoagulant in mechanical valve patients is challenging, Current recommendations focus on management in patients undergoing elective surgery, while the data in patients hospitalized for emergency/urgency non-cardiac surgery is limited. We aimed to identify thromboembolic and bleeding events after anticoagulant interruption in patients with mechanical heart valves hospitalized for emergency/urgent non-cardiac surgery. [...]

Case Presentation: A 36-year-old man with 2 prior mechanical valve replacement for congenital aortic valve stenosis presents to the hospital with 2-week history of fever, chills, fatigue, generalized weakness and malaise. He had his first aortic valve replacement at the age of 17 and redo for valve for restenosis of the aortic valve with severe [...]

Case Presentation: Our patient is a 77-year-old female with no past medical history who presented with two weeks of dyspnea on exertion, scant hemoptysis, and rhinorrhea with occasional blood. Vitals showed tachycardia, tachypnea, and hypoxia with saturations 95% on 15 L/min via heated high flow nasal cannula. Exam revealed accessory muscle use, faint bibasilar rales, [...]