Thread by @virenkaul

Everyone is busy at this time. Want to provide a summary of the @SCCM guidelines on #COVID19. Summary in tweets and details in accompanying pics.

Summary: We are dealing with viral ARDS albeit with it's own quirks. PPE, clean hands, standard high quality ARDS mgmt

#COVID19

Re: Infection control, diagnostics:
- Respirators for aerosol gen procedures + PPE
- Usual care: Surg masks + PPE
- bronchs, NIV: Highest risk for aerosolization
- Intubation by most exp provider
- In intubated pts, obtain lower resp samples over NP/OB swabs

#COVID19

Re: Resus
- Conservative fluid strategy
- Crystallois > Colloids
- 1st line: Norepi
- If no norepi: vaso / epi
- Target MAP 60 - 65
- Shock despite fluids/norepi + cardiac dysfunction: Dobut
- Refractory shock: Hydrocortisone 200 mg / d

#COVID19

Re: Vent support
- O2 for sats < 92%
- HFNO > NIV
- If no HNO, and no urgent need for intubation -> NIV trial
- Close monitoring of HFNO/NIV --> Early intubation
- LTVV, Pplat < 30

#COVID19

Mod - sev ARDS:
- Higher PEEP > Lower
- Prone for 12-16 hours
- Intermittent NMB > continous
- Vent dyssynchrony, ongoing deep sedation, proning, high Pplat: NMB x 48hours
- Consider recruit
- Consider ECMO

Rec against:
- Routine iNO, incremental PEEP

#COVID19

Re: Treatment
- MV w/o ARDS: No steroids
- MV + ARDS: Steroids
- MV: Empiric abx
- Tylenol for fever

Suggest against: Kaletra, IVIG, convalescent plasma

No recs: rIFN, HCQS, chloroquine, tocilizumab, other anti-virals

#COVID19

Finally two very helpful figures:
Mgmt of hypoxia: bit.ly/33CFUCe
Mgmt of ARDS: bit.ly/2xehmn5

Thank you @SCCM @SCCMPresident and the authors for taking this on and providing guidance at this difficult time for our community/patients.

#StrongerTogether