I know we’re worried about NIVPP w/ #COVID19, namely CPAP, but what are we treating w/ HFNC when these patients are hypoxemic? Are we treating the underlying pathophysiology or a number? One more than the other? This keeps me up at night. @PulmCrithttps://emcrit.org/ibcc/covid19/#noninvasive_ventilation_(BiPAP_&_CPAP) …
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Replying to @reverendofdoubt @PulmCrit
Also we are currently treating patients as airborne, so why intubation early? Also I worry this strategy will become dogma and become difficult to reverse in 1-2 weeks when vents are more short than ppe.
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Replying to @MikeRoseMDMPH @PulmCrit
Exactly!!! Exactly what I’m worried about. If they’re already on airborne precautions, it just doesn’t make sense to me and seems like a great way to make the vent shortage happen a LOT faster.
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Replying to @reverendofdoubt @PulmCrit
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What a helpful summary of evidence from @PulmCrit. Anecdote from@ripamrc (listen below) from step down unit in Milan up to ~ 80% on CPAP. Many benefits to CPAP outlined by@GiacomoMonti as well in episode.https://podcasts.apple.com/us/podcast/the-clinical-problem-solvers/id1446215559?i=1000468796272 …1 reply 1 retweet 4 likes
thanks- very limited personal experience myself with these patients so I’ve also found myself constantly citing that fantastic @CPSolvers episode supporting CPAP as an initial trial.
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