Caring for ICU patients with COVID-19

From the JAMA article by Murthy, et al on March 11, recommendations to consider in patients with COVID-19.

Multiple reports suggest high rates of ICU requirement among those hospitalized for COVID-19; per a meta-analysis of 656 patients, Rodriguez et al, as high as 20%, while data from Wu, et al in JAMA of 44K patients in China reported a lower, 5% rate of "critical" cases, but a stunning mortality rate of 49%. Their overall mortality, or officially, Case Fatality Rate (CFR) was 2.3%, a number capitulated in much of the (earlier) literature. Italy, by contrast? 7.2%, from data reported in JAMA yesterday by Onder et al. Needless to say, the US will have to crunch our own numbers as the pandemic progresses, but it is likely that many more, if not most, of physicians are going to become more familiar with critical care, one way or another.

A number of ICU resources exist. This is adapted from a SAGES list of links from March 21:

1. VIDEO: Behind the Knife Podcast: Ventilators – Simplified, by UT Houston Trauma fellow Dr. Patrick Georgoff, an excellent 23 min review of ventilator modes and basic management, resident level

2. SCCM – Critical Care for Non-ICU Clinicians: requires making a (free) account, has 8 clinical modules (2 on ventilator management), and 5 modules on disaster preparedness/response. Also has an app to play all their modules.

3. AAST: Mechanical Ventilation in the Intensive Care Unit: 2 paragraphs and some facts, the overarching basic ideas re: mechanical ventilation, and several links.

4. Annals of Thoracic Medicine: Rapid shallow breathing index: Utility of RSBI to predict successful vent weaning, and limits/considerations in special populations. Serial RSBI or RSBI rate are more valuable than isolated values.

5. NIH NHLBI ARDS Clinical Network: Mechanical Ventilation Protocol Summary: 2 page cheat sheet. Great to have in your white coat until it's all second nature.

6. REBELEM: Simplifying Mechanical Ventilation: 4 part series, a little lengthy. #1 is summarized in my 3/22 post

Image from JAMA article mentioned above: Murthy, et al. Care for Critically Ill Patients With COVID-19. Published online March 11, 2020. doi:10.1001/jama.2020.3633