ESICM guidelines highlight best practices for managing COVID-19 in ICU

  • Alhazzani W & et al.
  • Intens Care Med
  • 21/03/2020

  • Liz Scherer
  • Clinical Essentials
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Takeaway

  • The European Society of Intensive Care Medicine (ESICM) guidelines reinforce strategies to reduce COVID-19 transmission risk in ICU workers caring for critically ill, hospitalized adults.

Why this matters

  • In addition to other personal protective equipment, use fitted respirator masks (N95/FFP2) during aerosol-generating procedures vs surgical/medical masks.
  • Perform aerosol-generating procedures on ICU patients in a negative-pressure room (minimum 12 air changes/h, or at least 160 L/s/patient in facilities with natural ventilation).
  • Ensure that endotracheal intubation is performed by health care workers most experienced in airway management to reduce the number of attempts, transmission risks.
  • Close monitoring recommended for worsening respiratory status in adults receiving noninvasive, positive pressure ventilation or high-flow nasal cannula to ensure timely intubation.

Key points 

  • Avoid hydroxyethyl starches for acute resuscitation.
  • Mechanically ventilated patients with COVID-19 or acute respiratory distress syndrome (ARDS): use low tidal volume (Vt) ventilation (Vt 4-8 mL/kg of predicted body weight) vs higher (Vt>8 mL/kg), target plateau pressures ( 2 O). 
  • Use high positive end-expiratory pressure (PEEP) strategy (>10 cm H2O) for mechanically ventilated patients with COVID-19 or moderate/severe ARDS; monitor for barotrauma.
  • Avoid incremental PEEP recruitment maneuvers.