Some #COVIDDeepThoughts / reflections on clinical care in the #COVID #ICU now that I’ve had a chance to slow down a bit. It seems like a lot of folks are reaching for explanations for why #COVID19-related respiratory failure is something different & exotic & somehow not #ARDS.

As a result, a lot of pretty out there treatments with significant risks and downsides associated with them are being suggested by physicians, many of whom did not regularly care for #ARDS patients pre- #COVID19. These are being hyped up in the press & families are asking for them

I get it, it’s a lot less exciting to say “the patient recovered from #COVID19 w/ meticulous supportive #ARDS care” than it is to say “I did this weird new thing or gave this specific drug & the patient miraculously got better.” But #fundamentals >>> hype & unproven therapies

My patients improved with #ARDS fundamentals. While life-saving, these #fundamentals are also tedious, boring & laborious. The 4 Ps I preached to the housestaff ( #PEEP, #prone, #perky, #pee) can’t be done well if your hospital is overwhelmed & you don’t have enough staff or #PPE

You have to be at bedside to optimize #PEEP & other #ventilator parameters. You need a big team to #prone patients. You need to watch patients constantly to safely lift sedation and let them #perk up. Even #pee, the easiest P, requires attention to detail so you don’t overdo it.

You also need your team to buy into these #fundamentals as crucial and potentially life saving or they just won’t get done because...

if your team has bought into the false narrative being perpetuated that almost all vented patients die, why on earth would they risk exposing themselves while doing these things if the outcome is just going to be dismal anyway?

Finally, the emphasis on fundamentals does not take away from the need to #innovate & find new therapies. Research is needed so we can do better, as even w/ the most meticulous care, too many patients won’t survive. But let’s not abandon what was working before, let’s build on it