Covid 19 Education

Peak

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The AACN has a free course on COVID 19, ARDS, and Vent managment. I haven't gone through the course but probably a good resource for those who want to brush up.

 

Akulahawk

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I just went through the course. It's about 4 hours. While I'm not sure if they'll actually award CE for this, it's actually a good use of my time because it's a decent, if introductory, course in respiratory failure and ARDS. They also cover weaning and extubation/decannulation. As an ED RN, I likely won't use some of that info but I'm certainly not worse off for having spent a few hours of seat-time going over that info. For an ICU RN that's very experienced in dealing with resp failure and ARDS, it's probably not worth it unless your employer mandates it. It also doesn't seem to cover COVID19 specifically but beyond the isolation end of it, I suspect not much else would be needed from this kind of course anyway.

So, I second Peak's recommendation that it's "a good resource for those who want to brush up."
 

VentMonkey

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@Peak thanks for sharing. I've forwarded the link to our program manager for our clinicians.
 

Akulahawk

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Since the "host" is the AACN, they've made the info free for nurses. I don't know if they'll still allow it to be free for non-nursing personnel. As I indicated above, it's a good basic intro to ventilators, respiratory failure and ARDS.
 

VentMonkey

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Since the "host" is the AACN, they've made the info free for nurses. I don't know if they'll still allow it to be free for non-nursing personnel. As I indicated above, it's a good basic intro to ventilators, respiratory failure and ARDS.
Yes, it’s free for non-nursing personnel as well. I completed the modules yesterday on my downtime. CE-wise, I couldn’t tell you.

If you’re a critical care provider it is, as stated, a good refresher. It also served as a good ABG review.

And yes, there was maybe one actual COVID reference to the whole thing. It’s aimed more at the care of a patient in (impending) ARDS, which seems pertinent since the ones who’ve died thus far have all seemed to have gone down this road.

Also, FoamFrat has a good 40 minute podcast with an intensivist in Chicago who’s currently working in a COVID ICU.
 

silver

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And yes, there was maybe one actual COVID reference to the whole thing. It’s aimed more at the care of a patient in (impending) ARDS, which seems pertinent since the ones who’ve died thus far have all seemed to have gone down this road.
Interestingly we aren't sure why some of the patients are in the easy to ventilate w/ normal compliance category and stay there while others quickly progress to a lower compliance state with severe ARDS. Now more than ever we need every provider to stick to true lung protective ventilation even if its for a short 911 ride or transfer between facilities thus everyone should brush up (or learn for the first time).
 

VentMonkey

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Interestingly we aren't sure why some of the patients are in the easy to ventilate w/ normal compliance category and stay there while others quickly progress to a lower compliance state with severe ARDS. Now more than ever we need every provider to stick to true lung protective ventilation even if its for a short 911 ride or transfer between facilities thus everyone should brush up (or learn for the first time).
It seems to me that even the intensivists on the frontlines aren’t quite sure how to go about approaching these patients.

The one I listened to in this podcast was along the lines of your approach to their management. He was also encouraging—in these cases specifically—early advanced airway management.

Others have been quite the opposite. Though this may very well have been a result of the daily, ongoing, rapidly-evolving changes we’re seeing in the both the virus, our approaches to care, and it’s patient toll/ their outcomes.

Thoughts?...
 

silver

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It seems to me that even the intensivists on the frontlines aren’t quite sure how to go about approaching these patients.

The one I listened to in this podcast was along the lines of your approach to their management. He was also encouraging—in these cases specifically—early advanced airway management.

Others have been quite the opposite. Though this may very well have been a result of the daily, ongoing, rapidly-evolving changes we’re seeing in the both the virus, our approaches to care, and it’s patient toll/ their outcomes.

Thoughts?...
I think one of the challenges has been the fact that everyone has very different patient demographics (Seattle vs NYC vs China vs Italy). Our (hospital) ICUs have nearly 100 patients now so we will get a sense of what works and doesn't for our patients very quickly. Right now we are intubating people early due to rapidly progressing hypoxemia and trying to bypass NIV to reduce aerosilization, but that will change as we run out of vents. We are finding that patients have a high respiratory drive and are dyssynchronous w/ significant desaturation, thus heavily sedated, no early SAT/SBT. Following ARDSnet w/ aggressive titrate of PEEP/FiO2, considering early paralysis and proning in people (looks like it is helping, but the ICUs I work in don't prone yet). Some patients just need like 8-10 of PEEP and FiO2 40% though (these likely will be the patients who we try to keep on NIV once vents run out). Very gentle fluid resuscitation (30ml/kg initial bolus in standard sepsis treatment is out) and instead pressors to help keep the lungs dry.
 

E tank

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I think one of the challenges has been the fact that everyone has very different patient demographics (Seattle vs NYC vs China vs Italy). Our (hospital) ICUs have nearly 100 patients now so we will get a sense of what works and doesn't for our patients very quickly. Right now we are intubating people early due to rapidly progressing hypoxemia and trying to bypass NIV to reduce aerosilization, but that will change as we run out of vents. We are finding that patients have a high respiratory drive and are dyssynchronous w/ significant desaturation, thus heavily sedated, no early SAT/SBT. Following ARDSnet w/ aggressive titrate of PEEP/FiO2, considering early paralysis and proning in people (looks like it is helping, but the ICUs I work in don't prone yet). Some patients just need like 8-10 of PEEP and FiO2 40% though (these likely will be the patients who we try to keep on NIV once vents run out). Very gentle fluid resuscitation (30ml/kg initial bolus in standard sepsis treatment is out) and instead pressors to help keep the lungs dry.
What's your vent situation?
 
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Peak

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Still room to go, don't know the actual number. Not sure that we have the nursing actually.
We have plenty of vents for now, but even if we got more I don't think we actually have the nursing staff to support it. We essentially have enough vents for every single adult and pediatric ICU bed, but if we overflow vents somewhere else we don't have enough critical care staff to actually run them.
 

DesertMedic66

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We have plenty of vents for now, but even if we got more I don't think we actually have the nursing staff to support it. We essentially have enough vents for every single adult and pediatric ICU bed, but if we overflow vents somewhere else we don't have enough critical care staff to actually run them.
There has been talks in my area of possibly contracting out flight crews to the local hospitals. The flight crews would assist where needed and handle the less complex vented patients, to free up RTs for the complex cases. It’s just a worse case scenario at this point.
 

Akulahawk

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We have plenty of vents for now, but even if we got more I don't think we actually have the nursing staff to support it. We essentially have enough vents for every single adult and pediatric ICU bed, but if we overflow vents somewhere else we don't have enough critical care staff to actually run them.
At my hospital, we're essentially in the same boat. Fortunately we don't yet have significant numbers of COVID19 patients but I'm sure that's going to change. We apparently have enough vents for our current ICU rooms and for the ED rooms that we'll have our COVID19 patients in but we're also expecting to receive a few more vents soon to expand the number of beds that can have vented patients. The tough part is getting the nursing staff to be able to care for all those vented patients. I suspect that in a relatively short time our ED nurses will end up basically becoming ICU nurses for lower acuity patients and we're orienting floor, surgical, and OB nurses with tele experience to the ED. What's really going to cause problems is making sure we have enough RT's to manage the vents.
 

silver

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We essentially have enough vents for every single adult and pediatric ICU bed, but if we overflow vents somewhere else we don't have enough critical care staff to actually run them.
Oh we are way over the number of original ICU beds in the hospital. Though the ICU beds/capita in NYC is somewhat less than elsewhere.
 

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