Coronavirus (COVID-19) Update: Critical Care Management

Noninvasive ventilation (NIV) , working with dying patients’ families, use of experimental therapies, and more. Derek Angus MD, MPH, FRCP, Distinguished Professor and Chair of Critical Care Medicine at the University of Pittsburgh, provides a COVID-19 ICU management update. Originally broadcast on Wednesday, April 1, 2020 at 13:00 CST (GMT-05:00).

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Topics discussed in this interview:
0:00 Introduction

2:00 Say you have 100 patients come into the hospital with COVID-19. It looks like about a third end up in the intensive care unit. How do they do once they're in the intensive care unit?

7:00 There's been some tension about early intubation versus waiting. Do you want to comment on that or just not enough information?

8:16 There are reports of people who are developing acute respiratory distress syndrome (ARDS) and deteriorating very quickly. Do you have a sense of that in your ICU?

9:56 There's been some reports that for the people who get intubated they appear to stay on mechanical ventilation for a longer period of time than people's other experience with ARDS but again, this is observational information.

12:52 Case-fatality once you're intubated is high. From looking at the various reports, talking to your colleagues, do you have a sense of what it is?

15:05 As someone who runs a lot of ICUs, what's your greatest fear?

17:48 What's your sense of the clinical trials? Where will they be successful? Should they be tried in very sick people or is the goal to try some of them in less sick people to prevent those people from needing the intensive care unit?

22:27 Do you have a sense - is it going to be the antivirals, is it going to be this so-called cytokine storm that we can intervene with, will it be chloroquine? Do your instincts tell you that there is going to be a big gain with one of these new therapies?

26:45 Do you understand the exuberance around chloroquine?

29:00 Are there any clinical trials focused on preventing mildly ill patients from needing ICU care or have most of them been focused on the more ill patients?

32:10 Visitation is remarkably limited and their loved ones are dying and are going to die. Either they're on a ventilator or they've been appropriately extubated to spend their last few hours in comfort. How do you imagine that playing out in the US?

38:39 How soon do you think we'll get results from the randomized trials?

40:58 What is the primary outcome in most of the trials?

41:52 Would you use one ventilator for two patients if ventilators are scarce?

42:45 What do you think the 900,000 physicians who aren't intensivists need to know?

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Видео Coronavirus (COVID-19) Update: Critical Care Management канала JAMA Network