Thread by @PedsIntensiva

1/39 2nd podcast & tweetorial for Pediatrica Intensiva, the art & science of pediatric intensive care. Here, an update on the realities of battling a tsunami of #COVID19 with intensivists Giovanna Colombo & Lorenzo Grazioli from Bergamo, Italy

#ICU #pedsICU

Here's the link to the recording

podcasts.apple.com/au/podcast/ped…

2/39 But first, a story about 2 real life heroes in the midst of #COVID19. #ICU & #pedsICU docs Giovanna Colombo & Lorenzo Grazioli are working in the epicentre of the outbreak. They’ve seen countless deaths & know that to save many they can’t save all

3/39 In the face of the #COVID19 tsunami they make superhuman efforts but are unable to provide anything like usual care. Reverse triage & impossible decisions daily. Even ICU or intubation is unavailable for perfectly healthy people > 70 years old

4/39 But some are too young to die. A new mother, at a small hospital nearby. Intubated, ventilated, dying. #ECMO is near impossible, even for their own inpatients. They are exhausted, heartbroken, almost spent. Dealing w sick friends & relatives themselves #ICU #pedsICU #COVID19

5/39 But some are too young to die. Somehow, they organise an ad hoc #ECMO retrieval. Drive the ambulance themselves. SaO2 75% when they arrive. Sliding away. VV ECMO cannulae in. Stable.

Still, today, some are too young to die #ICU #pedsICU #COVID19

For some reason iTunes takes a while to update. Link above to show, this is the episode link

podcasts.apple.com/au/podcast/2-2…

Here is the link to the episode

podcasts.apple.com/au/podcast/2-2…

6/39 “The #COVID19 crisis goes from theoretical to real very quickly. The generosity of the Italian medicos taking the time to share their experience in the middle of a #COVID19 pandemic has helped people all around the world to take it seriously & prepare”

#ICU #pedsICU

7/39 “A week ago we thought we were ahead of the game outside Italy but realised we weren’t even asking the right questions about #COVID19"

#ICU #pedsICU

8/39 “In Bergamo, N Italy, pop ~ 1 mil, at least 300 people per day are dying of #COVID19. We are underestimating because many elderly ppl dying at home without hospital care are not being tested. There are too many to bury & the army is moving the bodies out”

#ICU #pedsICU

9/39 “The situation we are facing with #COVID19 in Italy was completely unexpected. We are trying to deal w the situation but we realise now that our preparations were NOT enough”

#ICU #pedsICU

10/39 “We hope that #COVID19 patients start to decrease soon because restrictions were put in place in Italy , finally, some time ago. But we have so many patients, who are so critical for so long, inside the hospital, that we cannot cope even with our inpatients”

#ICU #pedsICU

11/39 “We are completely full in Lombardy region & have not been able to admit to ICU for 24 hours. We are moving the more stable critical #COVID19 pts to less severely affected regions. Many are too unstable for transport & it is resource intensive”

#ICU #pedsICU

12/39 “Our #COVID19 ICU mortality is not that high - if we can get the patients in. We are trying to set up a #COVID19 field hospital for extra capacity but lack equipment, ventilators & skilled staff. We can't even recruit internationally”

#ICU #pedsICU

13/39 “Critical #COVID19 pts are hypercoagulable. CT angio pulm thromboembolism in 2/3. ?vasculitis or microangiopathy. Now anticoagulating w heparin, not just prophylaxis. Pulm HT uncommon but some have received fibrinolysis w improved hemodynamics & RV function”

#ICU #pedsICU

14/39 “Critical #COVID19 pts are hypercoagulable 2. CRRT circuits clot. Fibrin, like ECMO circuit after few days. Fibrinogen high, TEG shows high MA. Now anticoagulating w heparin, not just prophylaxis. One local hospital using aspirin prophylaxis. Need more data”

#ICU #pedsICU

Here's the link to the interview

podcasts.apple.com/au/podcast/2-2…

15/39 “It’s hard to treat critical #COVID19 across the whole hospital w so many clinicians, many non crit care trained. Prepare & share a good protocol BEFORE you hit this problem. @SCCM & others have now produced consensus recommendations as a start point”

#ICU #pedsICU

16/39 “Critical #COVID19 patients have a complex multisystem syndrome, not just simple ARDS. Involves lungs, inflammation, vessels, coagulation. We must understand it better to improve survival”

#ICU #pedsICU

17/39 “We’re starting to use darunavir rather than lopinavir for unwell #COVID19 patients bc of concerns about absorption of lopinavir via NG. Also hydroxycholoroquine. Unsure re. efficacy. Need data about efficacy & ideal timing bc the illness changes over time”

#ICU #pedsICU

18/39 “~10% bacterial superinfection, us lungs, in our critical #COVID19. Pt’s flora, enterococ & staph. We’re doing weekly BALs for aspergillus surveillance but only seen 2 cases. Minimal bloodstream infection despite use of invasive lines including PA catheters”

#ICU #pedsICU