Thread by @SRAnesthesiaICU

How we’ll we manage the first ten #COVID19 patients of 2021 (if any) hospitalized for #ARDS (compared to the first 10 patients we managed in February 2020). A multidisciplinary brain storming after managing approx 1000 such patients within the end of Apr 2020. A thread 1/ #FOAMed

2/
Not all our clinical impressions have already published evidence (but the majority was published), but our hospital #COVID19 mortality went close to zero in late April 2020 and we hope medical management accounts for at least part of these results.

https://twitter.com/giovannilandoni/status/1287743326620450818?s=20

3/
More, early ECMO. We put a dozen ECMO. We feel we should have put more of them and we should have done it earlier (eg after a couple of days of invasive mechanical ventilation with no improvement). @annamarascandro
@mgcalabroMD @md_monaco @MarinaPieri4
hsr.it/news/2020/magg…

4/
Less intubation. We’ll use invasive mechanical ventilation if respiratory distress will ensue. We managed hundreds of patients with CPAP, even if severely hypoxic, with excellent outcome results. @SergioColombo10 @GiacomoMonti @carlo_leggieri @ElenaMoizo @MucciMilena @tiniplu4

5/
Lower PEEP values and few-none recruiting manouvers in invasively ventilated #COVID19 patients (accepting even lower PaO2/FiO2). Once the patient is intubated: no hurry in weaning/extubation @SergioColombo10 @eleonoracolnag1 @danyfe80 @crimar701 @smartX82 @FanoGreta

6/
Less adjuvants (eg antivirals). #Remdesivir might be is the only one left with some evidence based medicine for benefit on secondary outcomes and (even if in early stages of the disease only and not in ICU patients).
@lorenzodagna @ambralicia @lurenz75 @CFrascoli @CiceriFabio

7/
More (early) anticoagulants (eg low molecular weight heparin prophylaxis in the emergency department and full dose in patients with high Ddimer or documented clots). @MLuisaAzzolini @BaiardoMartina @Alby_backkk @veronicadaless5 @alebelletti1 @simonatama ccr.cicm.org.au/supplementary-…

8/
More immunosuppressants (eg anakinra in all hyperinflammed #COVID19 patients and corticosteroids in ICU patients or in those on oxygen) @lorenzodagna @Chiara98298299 @ATornaghi @pacoitaly @stella69189016 @Racuffaro @AlessandroOrta1 @elenascarparo
thelancet.com/journals/lanrh…

9/
Little or no efficacy of IL-6 blockers (#tocilizumab / #sarilumab) on clinically relevant endpoints in #Covid-19 patients @FilippiniMarti @GaeLombardi @fede_morselli
@msartorelli91 @MargheritaTozzi @irenecampofreda @IChiodega
ard.bmj.com/content/early/…
ejinme.com/article/S0953-…

10/
Pronation (and respiratory physiotherapy) to every patient, starting in the emergency department and even during CPAP in the awake patient @MatteoMarzaroli
@Barbara58342884 @GiacomoSena @paola88385878
@90Crina @CarolinaFaust11 @GabrieleValsec3
jamanetwork.com/journals/jama/…

11/
We suggest early referral to high volume hospitals for future #COVID19 patients
Research is life
#COVID-19 patients should be enrolled in #RCTs
@antobellan15 @GabriTod @monicafedrizzi @simonegattarell @francichione @tscquizzato @RosalbaLembo