COVID-19 is NOT ARDS

Early intubation + high PEEP to treat hypoxemia may hurt patients

"It seems to be some kind of attack on the capillary-alveolar interface combined with some kind of hemoglobinopathy that I have never seen."

We need a new protocol https://thinkingcriticalcare.com/2020/03/28/covid-clinical-discussion-w-cameron-kyle-sidell-nyc-ed-icu-doc-in-the-trenches-foamed/

What follows are notes from an interview with @cameronks on March 28th...

Because COVID patients are showing the classic "ground glass" presentation on chest CTs that we associate with ARDS, we treat them as per ARDS protocol: early intubation, positive pressure ventilation

However, COVID patients have hypoxemia (low blood oxygenation) & pulmonary hypertension WITHOUT DYSPNEA (difficulty breathing)

this is not ARDS

COVID Syndrome is a new phenomenon more akin to Decompression Sickness ("the Bends") or HAPE (High Altitude Pulmonary Edema)

Patients need oxygen to treat hypoxemia, not positive pressure ventilation to treat respiratory failure

Putting patients on a vent with high PEEP (positive end-expiratory pressure) for an extended period may damage the lungs that hurts more than it helps

Instead, try to fix the hypoxemia itself with high-flow oxygen

Delay intubation longer than you'd expect!

Consider VV ECMO (veno-venous extracorporeal membrane oxygenation) if available

Emerging Treatment Regime:

Intubate ONLY when A) 90% oxygen is required to achieve sats in the high 80s *AND* B) patients are showing signs of respiratory distress (anxiety, tachypnea)

Post-intubation, set PEEP low––to just above what it would be with high flow oxygen

"I am in no way advocating to let people ride out at extremely low saturations. I just run into the quandary where I am quite sure that putting them on ventilator settings that are accepted & that I have been trained to do will possibly cause significant harm." - @cameronks

Dr. Cameron Kyle-Sidell, MD ( @cameronks) is an attending ED & Critical Care physician who runs the ICU at Maimonides hospital in NYC

I have done my best to accurately represent his words & his thinking

He talks about this more here: https://vimeo.com/402537849 

This is the Italian paper he references in the interview: https://www.atsjournals.org/doi/pdf/10.1164/rccm.202003-0817LE

I am a retired NYC Paramedic turned technology entrepreneur & investor in Silicon Valley. I've treated 1000s of patients & intubated 100s, but I stopped working in healthcare in 2010

I have shared & promoted this thread so that you may learn & others may live