MUST WATCH Video: Thinking CC COVID-19 Respiratory Management - A Physiological Approach via @emcrit https://emcrit.org/emcrit/covid-respiratory-management/ #COVID19FOAM

Includes @drlauraduggan @cameronks @PulmCrit @adamdavidthomas @ThinkingCC @EMNerd_ @emcrit

My take away messages to follow in tweetorial

General Principles:

All convos start with appropriate PPE
This is not a one size fits all dz
“Stop doing dumb shit”
Try not to intubate early where possible
Consider HFNC/NIV early instead of intubation
HFNC/NIV pts need to be monitored frequently as they become O2 dependent

Mechanical Ventilation:

Currently, the O2 threshold to intubate pts is unclear
When intubating pts O2 sats will drop, but they will come back up over 1 – 2hrs
Push should be for O2 1st, & pressure 2nd strategy
Uncouple PEEP from FiO2 (Don’t follow ARDSnet in high compliance pts)

Mechanical Ventilation contd:

Use an opiates 1st, & sedation 2nd strategy to help control respiratory drive
Keep PEEP at 8 – 10cmH20 in high compliance dz

Other Things to Consider:

Keep pts dry, but not too dry
Awake proning – move pts frequently but with alternating sides and sitting up (This is not just on stomach
Awake proning is not a recruitment strategy, but a strategy to shift blood supply to buy time