EMCrit Wee – Webinar I Gave to Pulm/Crit Care Fellows on Avoiding Intubation and Initial Ventilation of COVID19 Patients - a podcast by Scott D. Weingart, MD FCCM

 

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:





 



 



 



 



 



 

Further episodes of EMCrit Podcast

Further podcasts by Scott D. Weingart, MD FCCM

Website of Scott D. Weingart, MD FCCM