— By Dr KK Aggarwal

Reference A panel of 39 experts from 12 countries from across the globe developed the 50 recommendations within four domains, under the auspices of the Surviving Sepsis Campaign. They are issued by the European Society of Intensive Care Medicine (ESICM), and will subsequently be published in the journal Intensive Care Medicine.

FACTS

287: For healthcare workers performing aerosol-generating procedures on patients with COVID-19 in the ICU, use fitted respirator masks (N95 respirators, FFP2, or equivalent), as compared to surgical/medical masks, in addition to other personal protective equipment (eg, gloves, gown, and eye protection such as a face shield or safety goggles.

288: Perform aerosol-generating procedures on ICU patients with COVID-19 in a negative-pressure room.

289: For healthcare workers providing usual care for nonventilated COVID-19 patients, use surgical/medical masks, as compared to respirator masks in addition to other personal protective equipment.

290: We recommend endotracheal intubation in patients with COVID-19, performed by healthcare workers experienced with airway management, to minimize the number of attempts and risk of transmission.

291: For intubated and mechanically ventilated adults with suspicion of COVID-19, obtain endotracheal aspirates, over bronchial wash or bronchoalveolar lavage samples.

292: For adults with COVID-19 and acute hypoxemic respiratory failure, use high-flow nasal cannula [HFNC] over non-invasive positive pressure ventilation [NIPPV].

293: For adults with COVID-19 receiving NIPPV or HFNC, monitor closely for worsening of respiratory status and early intubation in a controlled setting if worsening occurs.

294: For mechanically ventilated adults with COVID-19 and moderate to severe acute respiratory distress syndrome [ARDS], go for prone ventilation for 12 to 16 hours over no prone ventilation.

295: For mechanically ventilated adults with COVID-19 and respiratory failure (without ARDS), don’t routine use of systemic corticosteroids.

296: For healthcare workers who are performing non-aerosol-generating procedures on mechanically ventilated (closed circuit) patients with COVID-19, use surgical/medical masks, as opposed to respirator masks, in addition to other personal protective equipment.

297: For healthcare workers performing endotracheal intubation on patients with COVID-19, use video guided laryngoscopy, over direct laryngoscopy, if available.

((The writer is President, CMAAO, HCFI and Past national President IMA))