Thread by @iceman_ex

Fascinating discussion from the @ICS_updates webinar

Differing opinions on HFNC, CPAP and intubation

The risk of P-SILI described by @bjoern_weiss

Versus the benefits of avoiding intubation

Again: NO ONE can predict who will successfully manage with noninvasive therapies.

Up to 50% of patients will manage with noninvasive therapies alone (CPAP/HFNC)

But which 50%? Does everyone warrant a trial? And where should this trial take place?

#icswebinar #covid19foam

The discussion around PEEP is ongoing

SuperPEEP is out. A modest level of PEEP (8-10) is suggested by @deoxyexplorer

Superdry for fluid balance is also out- euvolaemia is current target.

#icswebinar #covid19foam

Secretion management is proving challenging

-wet circuits
-NAC/saline nebulisation
-physiotherapy
-bronchoscopy
-physiotherapy

One size doesn’t fit all.

Thoughts @DrIntensive ? #icswebinar #covid19foam

Extubation proving challenging

Recommendations include checking for a cuff leak 🤨

#icseducation #covid19foam

Pulmonary vasodilators experience:

Makes numbers look better, but unclear as to whether there is an outcome benefit

(Surely preserve for those with RV dysfunction?)

Proning also a good RV therapy

#icseducation #covid19foam

Lots of discussion around the use of multiorgan POCUS for lung monitoring and particularly for fluid balance 🤨

(VEXUS?)

Now discussions about RRT. Are filters truly “clotting” or filling with inflammatory gunk?

#icseducation #covid19foam

Some of the renal failure we are seeing is suggested to be iatrogenic (?PEEP)

Some of it may well just be COVID renal infiltration

Keep sharing data peeps and contributing to national/international data registries (@ICNARC, @SCCM ) #icseducation #covid19foam

Discussions around anticoagulation

Should we routinely screen for DVT? I’d suggest if you have the #POCUS practitioners to do so, then consider it...

Observational data from a single centre- people stuck hypoxic all had proximal PEs 😳#covid19foam