General schema for respiratory support in patients with COVID-19 Low flow nasal cannula • Typically set at 1-6 liters/minute High flow nasal cannula (with Iimitation in the flow rate) CPAP • Titrate CPAP up as tolerated (in more severe hypoxemia might target ~15-18 cm) • Viral filter • N95 mask & aerosol precautions. • (Helmet interface possibly ideal) Invasive Mechanical Ventilation • Target tidal volumes of ~6 cc/kg. • Permissive hypercapnia may be useful to allow for lung-protective settings. • May use conventional lung-protective ventilation strategies or APRV. Prone positioning • Exact indication for prone ventilation is unclear. • Proning is a front-line therapy for refractory hypoxemia, but it's unclear whether it is beneficial in all patients with PaO2/FiO2 ratio <150. VV-ECMO • indicatons remain unclear. • Early discussion With ECMO center or team may be advisable. Internet Book of Critical Care @iBookCC #respiratory #support #COVID19 #management #schema #criticalcare #hypoxia #failure #algorithm
