1. Possible COVID+ initial vent strategy to fit hypoxemic failure: FiO2 100%, Peep LOW as possible to achieve SpO2>75%. Consider every increase in PEEP carefully, risk of lung injury. Ideally breathing on own -> CPAP, narcotics to slow RR +- moderate sedation.
2. Would awake intubation of COVID+ patient w/ Full PPE be possible?? Allow for continued breathing, no pressure support -> reduce lung injury. Goal is to increase oxygen, reduce pressure. If vent strategy can fit disease, possible early intubation not harmful. #oxygennotpressure
3. Maintenance vent strategy: Leave on FiO2 of 100%, tolerate SpO2 > 75% (arbitrary number, suggestions welcomed!) When virus halts, SpO2 should rise. When hits 100%, no fevers, perhaps disease gone. Should be able to rapidly (over 1 - 2 days) decrease FiO2
4. Understand that even when intubated, disease continues. Never drop FiO2 until confident disease gone. Prone if cannot achieve SpO2 > 75% w/ PEEP < 8 - 10 (may differ based on BMI). Always consider proning to buy time prior to going up on PEEP. Consider not paralyzing to do so.
5. Keep net even to net negative. Patient's vitals should be the same after you intubate as they were before. If hypotension presents post-intubation, drop PEEP, consider tolerating lower SpO2.
6. These recommendations are based on OBSERVATIONS, both my own, and those with far more experience, including Gattinoni. Represent a new strategy for a new disease. Comments, suggests, criticism: all are highly encouraged! We can change this, and the time is now! #thetimeisnow
