Covid-19 Respiratory Management Guidelines
We have gathered all of our most current Covid-19 respiratory management information together into one post. Please continue reading below and find additional downloadable PDFs and a link to our COVID-19 ARDS lecture at the bottom of this post.
Mechanical Ventilation:
1. Differentiate between L and H Type ARDS upon INTUBATION
2. L Type ARDS is defined by:
a) Preserved respiratory system compliance of >40 mL/cm > H2O (Tidal volume/Driving Pressure) b) Initial plateau pressures 29 or less
c) D Dimer usually very higher=thrombosis
d) “DEAD SPACE” likely =Check GAP pCO2-ETCO2 is >20
e) Positive DVT/PE on imaging
f) Resp Alkalosis
3. H Type ARDS is defined by:
a) STIFF LUNGS = REDUCED system compliance of <35 mL/cm > H2O
b) Initial plateau pressures 30 or greater
MANAGEMENT:
4. If L Type ARDS then place the patient on the Low Peep ARSDnet Protocol. While following driving pressures can usually allow higher TVs up to 8cc/kg . THEN follow DRIVING PRESSURES keep <15. For OPTIMUM PEEP to max
No RECRUITMENT
5. If H Type place on the High Peep ARDSnet Protocol. While following driving pressures usually have to focus on smaller TVs within the 4-6cc/kg range
6. Must follow Driving Pressures which are the difference between Plateau Pressures and PEEP. Target a driving pressure of less than 15
7. Self, manual, or rotoprone bed for any patient with a P/F ratio less than 150
a) 16hrs prone (5 mins 20 degrees prone bilateral with 30 mins prone) and 4hrs supine with the rotoprone bed b) 8hrs prone and 2hrs spine if manual prone
c) 1hr prone and 2 hours supine if self-prone
8. Allow permissive hypercapnia to a pH of 7.2=LOWER RESP RATE as much as possible 9. To adjust driving pressures can both change the PEEP (within ARDSnet) and fluctuate tidal volumes within the range of 4-8ml/kg
10. In obese patients allow a Plateau pressure of 35 and follow H type ARDS – High Peep Protocol
11. FOLLOW ETCO2 for DEAD SPACE? LOOK for AUTOPEEP and CHECK ECHO
12. FOLLOW CXR and ABGs DAILY unless otherwise specified
