No role for trial of CPAP? Seems like a fast way to exhaust ICU resources..https://twitter.com/wuidq/status/1240750407716089856?s=21 …
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GrepMed Retweeted WuidQ: Washington University ID Questions
No role for trial of CPAP? Seems like a fast way to exhaust ICU resources..https://twitter.com/wuidq/status/1240750407716089856?s=21 …
GrepMed added,
There has been discussion that CPAP aerosolizes a lot of virus and that people who need CPAP almost all need intubation within a few hours, so it’s most often been recommended to go straight to intubation. Take my reply with a grain of salt; I’m not Pulm.
The risk is aerosolization without proper PPE. It's simply not true that all of them crash. Many of these patients do well on NiV- CPAP widely used in Italy and HFNC in NY per recent @emergencypdx podcast. Per Italy reports the non-responders declare themselves in a few hrs
4/ If you've personally had experience with pts who progress from 5L NC to maxed on HFNC(aka CPAP 5) in 6hrs and then turn around with BiPAP, feel free to respond.
again i’m not saying NiV and disappear but short trial of NiV for a couple of hours might be wise to see who flies and who doesn’t. linked ERCast suggests they’ve significant reduced # of intubations using that strategy
2/ one caveat, the severely ill ones don't turn around. Like the intubated ones, you're in for a long 7-14 days of HF or BiPAP. Exhausting.
Yes Dr Strayer did say they managed to avoid ED intubation much more frequently using HFNC first approach but caveat was unclear in how many just delaying inevitable
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