By vgreene, 22 March, 2020 Fluids. Conservative IVF strategy in pts w/o tissue hypoperfusion;1,2 avoid positive fluid balance3
By vgreene, 22 March, 2020 Position. Semi-recumbent position (head of bed up 30-45°);1 consider prone position in severe ARDS2,3 if setting capable and PPE supply adequate1,2
By vgreene, 22 March, 2020 Recruitment. Use careful recruitment maneuvers (not sustained inflation);3 if used, monitor response,1 avoid staircase.2 Avoid vent disconnect (eg, for transport, suction)1
By vgreene, 22 March, 2020 Titrate PEEP at mod-elevated levels (eg, 10-15 cmH2O);3 max PEEP 15 in younger children, per WHO.1 If severe ARDS, PEEP >15 may be required but keep to PP limits.3 Target PP
By vgreene, 22 March, 2020 Permissive hypercapnia: Consider for mod/severe dz (exceptions exist); maintain pH 7.15-7.30, per PALICC3
By vgreene, 22 March, 2020 Intubation. Oral preferred vs nasal to ↓risk of VAP in adolescent; rapid-sequence OK after assessment.1 Pre-oxygenate1 w/ 100% FiO2 x5min, as rapid desat common during intubation, esp in young child, pregnant, or obese.1 Airborne precautions given co
By vgreene, 22 March, 2020 Isolate pt use droplet contact airborne precautions if COVID 19 suspected confirmed Use mechanical ventilation1 adjunctive care to maintain O2 sat