EMCrit Podcast - Critical Care and Resuscitation

 

ESICM Webinar Mentioned


* ESICM Seminar on COVID Ventilation


Read this to See the Thoughts of Actual Smart People


* in ICM


M. Ramzy's Infographic on the Article


Subtypes of COVID

Mild


Silent Hypoxemia (can cause iatrogenic injury when patients are intubated in this phase)


Indolent- Fine then Not (Intubated or Not-Inflammatory Markers)


Hyperacute


 

Cytokine Storm

Hemophagocytic Lymphohistiocytosis (HLH) Overlap / DIC


 

PathoPhys

Loss of hypoxic vasoconstriction


Micro-thrombotic disease


 

Avoidance of Intubation

Tachypnea, hypoxemia, do not seem to be indication


Mental status, Increased Dyspnea, PaCO2 rising


 

Progression of Therapies

NC


Venti


NRB+NC


Hi Flo with Surg Mask


CPAP—must monitor for excessive WOB


 

Non-Intubated Proning

ask them to move


 

Run them Dry

but not too dry--must replace external and insensible losses or else badness ensues


 

How to not kill patients with Intubation

EMCrit Airway Page


 

How to Ventilate

High FiO2 Strategy—Normal Compliance Patients

8 ml/kg, high fiO2


keep checking Driving Press and Plat


Avoid the PEEP Tables


Driving Pressure <=15


Proning


 


Prost/NO


 

Low Compliance Patients

6 ml/kg


Conventional Low Vt PEEP Table


Driving Pressure > 15

APRV

works for either subtype


if experienced, should be dominant mode of ventilation


 

Other Meds


* Heparin

* Steroids


 

Here is the Video Version


Audio Version Here:



 


 


 


 


 


 

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