EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients

ESICM Webinar Mentioned

* ESICM Seminar on COVID Ventilation

Read this to See the Thoughts of Actual Smart People

* in ICM

M. Ramzy's Infographic on the Article

Subtypes of COVID

Mild

Silent Hypoxemia (can cause iatrogenic injury when patients are intubated in this phase)

Indolent- Fine then Not (Intubated or Not-Inflammatory Markers)

Hyperacute

Cytokine Storm

Hemophagocytic Lymphohistiocytosis (HLH) Overlap / DIC

PathoPhys

Loss of hypoxic vasoconstriction

Micro-thrombotic disease

Avoidance of Intubation

Tachypnea, hypoxemia, do not seem to be indication

Mental status, Increased Dyspnea, PaCO2 rising

Progression of Therapies

NC

Venti

NRB+NC

Hi Flo with Surg Mask

CPAP—must monitor for excessive WOB

Non-Intubated Proning

ask them to move

Run them Dry

but not too dry--must replace external and insensible losses or else badness ensues

How to not kill patients with Intubation

EMCrit Airway Page

How to Ventilate

High FiO2 Strategy—Normal Compliance Patients

8 ml/kg, high fiO2

keep checking Driving Press and Plat

Avoid the PEEP Tables

Driving Pressure <=15

Proning

Prost/NO

Low Compliance Patients

6 ml/kg

Conventional Low Vt PEEP Table

Driving Pressure > 15

APRV

works for either subtype

if experienced, should be dominant mode of ventilation

Other Meds

* Heparin

* Steroids

Here is the Video Version

Audio Version Here: