By vgreene, 22 March, 2020 ECMO. If refractory hypoxemia despite lung-protective ventilation, consider ECMO1
By vgreene, 22 March, 2020 Position Consider proning all severely ill pts requiring supplemental O2 incl HFNO or non invasive ventilation per WHO 1 consider trial of proning to improve SpO2 only if intubation not otherwise indicated per NIH 2 semi recumbent position head of bed up
By vgreene, 22 March, 2020 Isolate pt use droplet contact precautions if COVID 19 suspected confirmed Maintain O2 sat w mechanical ventilation or select noninvasive options1 2 early in course
By vgreene, 22 March, 2020 Lower TV 4 8mL kg PBW per ATS NIH WHO ESICM SCCM 1 2 4 5 6 mL kg per ICS 6 Start 6 mL kg PBW 1 5 increase to 8 if required 1 5 Target PP
By vgreene, 22 March, 2020 Intubation Oral preferred vs nasal to darr 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 about COV
By vgreene, 22 March, 2020 Use OI1,2 to determine ARDS severity in invasive ventilated pts. Use PaO2/FiO2 ratio1,2 in pts on CPAP/BiPAP w/ ≥5 cmH2O.1,2 ARDS severity:1,2