After a quick update from Desiree and Monty this piece focuses on Philadelphia Pennsylvania and gets into specifics regarding caring for COVID 19 positive patients.

As regards The Jefferson Hospital; where has the ICU "take over" expanded to? Have critical care ventilators been deployed to all new ICU beds or have acceptable compromises been made? "Staffing is tougher than the equipment" but how has a "critical care pool" system, prepared over a year ago, helped? What does the typical COVID 19 critical care patient look like? Enormous quantities of oxygen are being used by institutions to care for them, have there been issues with supply? What about aerosolisation issues regarding the virus? How many of these patients can be proned?

Crucially we get into the important differences between this - and the way it is treated - and acute respiratory distress syndrome (ARDS) patients. How do COVID 19 patients differ from 'usual' cases where ventilation or breathing assistance is used?

"What the renal teams are saying I respect, they've never seen anything like this" we're told, "the climb of creatinine, had a trajectory that is inconsistent with a cardio renal syndrome".

"This is a climb that is pushing us into almost round the clock use of the dialysis nurses to handle these patients [...] because they're encephalopathic, their BUN's [blood urea nitrogen] are very, very high - and because the creatinine trajectory has gone from '1' on Monday, to '3' on Tuesday, to '9' on Wednesday! This is astonishing."

Also, hear how a comprehensive approach to planning and innovative ideas about nurse training, upskilling and basic critical care education have helped.

Presented by Monty Mythen and Desiree Chappell with their guest, Herbert Patrick, Pulmonologist and Critical care physician, Jefferson Hospital, Philadelphia, Pennsylvania.

Thank you to our sponsor Edwards Lifesciences.

Edwards clinical education (ECE): https://www.edwards.com/clinicaleducation