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

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

  • curated by Liz Scherer
  • Clinical Essentials
Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

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.