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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:
View all episodes
By Scott D. Weingart, MD FCCM
4.8
18431,843 ratings
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:
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