Thread by @theABofPharmaC

🚨 New Guideline Published 🚨

Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with COVID19 🦠

Tweetorial on key clinical recommendations 👇🏻#CCM #ICM #COVID19 @ESICM @SCCM @CritCareMed

1️⃣COVID19 Testing in the ICU 🔬

➡️If pt is intubated, lower respiratory tract samples preferred > upper respiratory tract 🧫

➡️➡️Lower respiratory samples, prefer endotracheal aspirate >> bronchial wash or bronchoalveolar lavage 🧪

2️⃣Infection Control in the ICU

✅Recommend video-guided laryngoscopy for intubation

✅Aerosol-generating procedure➡️ require a negative pressure room & HCPs should wear fitted respirator masks + PPE

✅Non-ventilated OR non-aerosol-generating procedure➡️ med/surg masks + PPE

3️⃣Hemodynamic Support ♥️

COVID19 pt with septic shock⁉️

➡️Balanced crystalloid fluid resuscitation 💦

➡️Vasopressors 🎯MAP 60-65 mmHg NE☝️line ➡️ not available? use epi or vasopressin ✅

➡️hydrocortisone 200mg daily can be considered in refractory shock

4️⃣Ventilation

✅Start supp. O2 if SPO2 <90% with a goal SPO2 96%

➡️Suggest HFNC>NIPPV if acute hypoxemic resporatory failure (AHRF) is present

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5️⃣COVID19 associated ARDS

➡️Use low tidal volumes (Vt 4-8mL/kg) ➕ target 🎯 peak plateau pressures <30cm H20

Mod-severe ARDS
➡️Proning x 12-16 hours ✅
➡️NMBs x 48 hrs
⤴️ PEEP strategy >10cm H20 (monitor for barotrauma)

🛑Inhaled nitric oxide not recommended

6️⃣Pharmacologic Treatment

➡️Start empiric antibiotics 🦠
➡️APAP preferred for fever 🤒

Insufficient evidence for HCQ, IFN, or tocilizumab, or antivirals

Suggest AGAINST the use of
🚫IVIG, liponavir/ritonavir, convalescent plasma, steroids (unless ARDS is present)

Excellent work by a collaborative team of critical care providers, thank you for putting together this evidence based guideline in such a timely fashion! @CritCareMed @SCCM @ESICM

Please share for your CC providers to help guide the best care for our patients! #CCM #PharmICU