Episode 167: COVID Clinical Care Update

In this 167th episode I review the most recent changes that we’ve made to our protocols for caring for COVID patients and share a fantastic one page summary sheet that 3 of our ICU fellows put together. Huge thanks to Drs. Navarette, Herekar and Baronos for their work on this. It is available for download below. References are on the second page of the attachment.

4 Replies to “Episode 167: COVID Clinical Care Update”

  1. For intubation for surgery, I read about excluding all personnel not essential for the intubation to reduce aerosol exposure. It should definitely be done for positive or suspected patients, but for low risk patients, are you practicing exclusion from the OR until the airway is secure? If you’re treating everyone as covid+ until proven otherwise, is this step also necessary?

    1. For low risk OR intubations we are not using N95s for everyone in the OR, nor are we emptying the OR. Only the Anesthesia team uses N95s. It’s a good question though and I’d love to hear what others are doing.

  2. What are all the anesthesia related ways aerosolization occurs? Is the act of intubation aerosolizing? I understand how anything that causes a patient to cough would be risky: nebulizer, sometimes IV fentanyl, not waiting long enough for succinylcholine to take effect, LTA administration. Can you please educate me on this matter? Also, what are recommended ways to extubate a PUI after surgery? Administer one mL of 2% lidocaine via ETT? Deep extubation may lead to the need for positive pressure bagging via anesthesia circuit; however, awake extubation is more likely to cause coughing.
    I have also heard of providers using the bair hugger over the patient’s face as a barrier for intubation and extubation, but not using a simple face mask or nasal cannula after extubation (same for awake cases under spinal).

    Thank you for all of your work to help us be better providers!!

    1. I think intubation and extubation are high risk due to the chance of coughing and, with intubation, moving tissue out of the way to allow a direct path from trachea to room.

      We are starting to use plastic sheets as you mentioned but haven’t talked about deep versus awake. I don’t think I would advocate for deep extubation given the potential need to mask ventilate. And remember, if you put a viral filter on the end of the tube and they cough when the circuit is disconnected you still get some protection.

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