Thread by @Fluid_Academy

@jasonvanschoor Dear Jason. Thank you for this excellent thread. We are preparing ourselves @UZBrussel I would like to add some treatment recommendations on #COVID19 #COVID19BE from #paolo_pelosi in the following tweets:

@jasonvanschoor @UZBrussel 1/ Don’t use HFOV or NIV too much
2/ if saturation less than 95 or paO2/FiO2 less than 200 with/without RR higher than 25-30 breaths/min at FiO2 60% with CPAP by NIV (helmet preferred) after 15-30 min - intubate immediately

@jasonvanschoor @UZBrussel 3/ low tidal volume 4-6 ml/kg PBW with minimal RR to achieve pH above 7.2
4/ PEEP relatively high 13-15 cmh2O;

@jasonvanschoor @UZBrussel 5/ Minimal Recruitment Maneuvers;
6/ Compliance is good so Pplat is usually below 25-27 cmH2O (lungs are easy to ventilate) - with driving pressures below 13 cm H2O;
7/ Increase FiO2 even higher than 0.5 if needed;
8/ Start with usual very low paO2/FiO2 when intubated

@jasonvanschoor @UZBrussel 9/ chest Xray usually very bad bilateral - than use Rx and Echo - dont use CT scan for monitoring (only on admission) - make also a cardio echo for cardiac function and cardiac effusions;
10/ low medium use of Noradrenaline - since pts are sedated almost for 4-7 days initially

@jasonvanschoor @UZBrussel 11/ prone is very much useful and patients may be well responsive - but be very well organized since consider time to dress before entering the rooms;
12/ start patient weaning later - if you start earlier you can have problems;

@jasonvanschoor @UZBrussel 13/ make a BAL at entrance and once a week - remember that swab may be negative while BAL positive
14/ treat with antiviral cocktail (Darunavir or lopinavir) + ritonavir + oseltamivir + chloroquine 200x2 + AB in agreement with infectiologists;

@jasonvanschoor @UZBrussel 15/ limit fluids and increase Noradrenaline; maintain zero fluid balance
16/ no corticosteroids, no cytosorb - in case of NA higher than 0.7 use only hydrocortisone 100 x3 (very few days);
17/ use of ecmo is rare