MICU Day #7: Disclaimer: I am an Intensivist, not an ID doc. What follows are lessons learned from 7 days of caring for COVID patients. There are no RCTs or solid evidence in this message, just my personal experiences, feelings, and current beliefs (highly subject to change).
1.Everyone needs to be reminded to not run to a code without appropriate PPE (even in radiology, even in a “non-COVID” patient), and we need to limit the number of teams/people that go at all. We can’t save anyone if we get sick!
2.Nothing feels better than extubating a COVID patient. When that patient has been intubated for 26 days, it is the absolute best.
3.I have had to become braver about not intubating patients. I think we should avoid intubation if at all possible. I have previously been an advocate of intubating early to ensure safe, non-emergent intubating conditions. My perspective is shifting.
4.I have always been a believer in APRV for mechanical ventilation in ARDS. I remain a believer in APRV for ARDS – even when it is caused by COVID.
5.I am a believer in adult tummy time (aka proning) – for those who are intubated and those who are not.
6.The hypercoagulability that accompanies COVID is real. I am following D-Dimers, aggressively looking for clots, using BID Lovenox for prophylaxis, and checking antiXa levels to ensure appropriate dosing.
7.I am not yet brave enough to therapeutically anticoagulate all patients, and my most recent patient with a transfusion-requiring-bleed reminded me why. I may still be convinced otherwise
8.Seraph filters hold promise. A Seraph filter is used to bind virus and inflammatory markers and is used with standard dialysis pumps. I have seen one erase fevers and vasopressor requirements. I would like to emphasize the ONE, but it brings me hope.
9.I have yet to be convinced that any medication makes a difference. Please convince me!
10.I am convinced that are nurses and RTs make a HUGE difference. I am so proud to call them colleagues and friends.
11.Finally, this disease sucks! It prays on our worst fears. It leaves patients fighting without the support of families, and it leaves families grieving without hope of closure. I will celebrate a vaccine – and I hope that we can convince folks to use it!
