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
By vgreene, 22 March, 2020 Higher5 PEEP favored in mod/severe ARDS1-3,5 (conditional recommendation, per ATS).4 Avoid vent disconnection (eg, for transport, suction).1 If using recruitment maneuvers4 in mod/severe ARDS, don't staircase;2,3 do monitor for response1
By vgreene, 22 March, 2020 Lower TV: 4-8mL/kg PBW per ATS, NIH, WHO, ESICM/SCCM;1-4 ≤6 mL/kg per ICS.5 Start 6 mL/kg PBW,1,4 increase to 8 if required.1,4 Target PP
By vgreene, 22 March, 2020 Intubation. Oral preferred vs nasal to ↓risk of VAP in adolescent/adult; rapid-sequence OK after assessment.1 Pre-oxygenate1 w/ 100% FiO2 x5min, as rapid desat common during intubation, esp if pregnant or obese.1 Airborne precautions given concern ab
By vgreene, 22 March, 2020 Not recommended: routine inhaled nitric oxide,3 HFJV,3 HFPV;3 insufficient data re chest PT3
By vgreene, 22 March, 2020 Neuromuscular blockade by continuous infusion not routine but consider for some pts, per WHO,1 NIH;2 consider if sedation alone inadequate, per PALICC3
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 Consider proning all severely ill pts requiring supplemental O2 incl HFNO or non invasive ventilation per WHO1