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Posted by ULY CLINIC

24 Machi 2021 15:12:58


The guidance  is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.




Patients with hypoxemic respiratory failure may require intubation and mechanical ventilator support. Detailed recommendations on ventilation strategies are beyond the scope of this guideline. Always consult an intensivist if possible, or alternatively a practitioner experienced with mechanical ventilation.

Nonetheless, the general principles to consider include:

• Individualize ventilator strategies based on respiratory mechanics and disease progression.

• Use lung-protective ventilation strategies for patients with established ARDS who have low lung compliance.

• Aim for an initial tidal volume of 4-6ml/kg, higher tidal volume up to 8 ml/kg predicted body weight might be needed if minute ventilation requirements are not met in a patient with good lung compliance.

• Strive to achieve the lowest plateau pressure possible. Plateau pressures above 30 cmH20 are associated with an increased risk of pulmonary injury.
• Hypercapnia is permitted if meeting the pH goal of >7.15-7.20.

• Application of prone ventilation 12-16 hours a day is strongly recommended for patients with severe ARDS.

• In patients with moderate or severe ARDS, identifying optimal PEEP levels will require titration of


• The use of deep sedation may be required to control respiratory drive, achieve tidal volume targets, and assist with patient-ventilator dyssynchrony.

• In patients with moderate-severe ARDS (SPO2<80%), neuromuscular blockade by continuous infusion should not be routinely used. Continuous neuromuscular blockade may still be considered in patients with ARDS in certain situations: ventilator dyssynchrony despite

• Sedation, such that tidal volume limitation cannot be reliably achieved; or refractory hypoxemia.

• Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis.

Use closed system catheters for airway suctioning and clamp endotracheal tube when disconnection is required (for example, transfer to a transport ventilator). A high efficiency particulate filter on the expiratory limb of the ventilator circuit should be used.

Routine Care –for intubated patients

Use principle FAST HUGS BIB
• F Feeding
• A Analgesia
• S Sedation
• T Thromboembolic prophylaxis
• H Head of Bed Elevated
• U Ulcer prophylaxis
• G Glycaemic control
• S Spontaneous breathing trial
• B Bowel regimen
• I Indwelling catheters and lines
• D Deescalate ,Antibiotics

F Feeding

• Assure the type of diet the patient is receiving.
• Ensure optimal diet is provided
• If NPO, perform regular assessments if oral feeding is indicated
• If projected to be NPO for a long time, ensure consultation is made for TPN be considered.

A Analgesia

• Ensure adequate pain control
• Assess regularly on the need for non-opioid adjuncts
• Consider adding oral analgesics instead of IV infusions

S Sedation

• Ensure sedation is minimized as much as possible
• Assess for non-benzodiazepine strategy use.

T Thromboembolic prophylaxis

• Ensure the patient is receiving VTE prophylaxis
• Assess for possible VTE adjustment for renal function.

H Head of Bed Elevated

• Head elevation to at least 30 degrees.

U Ulcer prophylaxis

• Assess for and provide stress ulcer prophylaxis
• Discontinued stress ulcer prophylaxis when indicated

G Glycaemic control

• Ensure adequate glycemic control (blood glucose target generally 6-10mmol/L).

S Spontaneous breathing trial

• Perform weaning protocol to assess if the patient qualifies for a spontaneous breathing

B Bowel regimen
I Indwelling catheters and lines
D Deescalate ,Antibiotics

B Bowel regimen

• Assess for bowel routines

I Indwelling catheters and lines

• Assess if the central line or arterial line can be removed.
• Regularly assess for the indication of a Foley catheter.

D Deescalate ,Antibiotics

• Assess and judge for patient’s antibiotics use, be narrowed or discontinued


25 Machi 2021 07:26:22



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