HJAR May/Jun 2020

20 MAY / JUN 2020 I  HEALTHCARE JOURNAL OF ARKANSAS AMERICAN ASSOCIATION FOR RESPIRATORY CARE SARS CoV-2 GUIDANCE Ventilation Recommendations from the SCCM task force In adults with COVID-19, we suggest starting supplemental oxygen if the peripheral oxygen saturation (SPO2) is < 92%, and recommend starting supplemental oxygen if SpO2 is < 90% In adults with COVID-19 and acute hypoxemic respiratory failure on oxygen, we recommend that SpO2 be maintained no higher than 96%. For adults with COVID-19 and acute hypoxemic respiratory failure despite conven- tional oxygen therapy, we suggest using HFNC over conventional oxygen therapy. In adults with COVID-19 and acute hypoxemic respiratory failure , we suggest using HFNC over NIPPV. In adults with COVID-19 and acute hypoxemic respiratory failure , if HFNC is not available and there is no urgent indication for endotracheal intubation, we suggest a trial of NIPPV with close monitoring and short-interval assessment for worsening of respiratory failure. We were not able to make a recommendation regarding the use of helmet NIPPV compared with mask NIPPV. It is an option, but we are not certain about its safety or efficacy in COVID-19. In adults with COVID-19 receiving NIPPV or HFNC, we recommend close monitor- ing for worsening of respiratory status, and early intubation in a controlled setting if worsening occurs. In mechanically ventilated adults with COVID-19 and ARDS, we recommend using low tidal volume(Vt) ventilation (Vt 4-8 mL/kg of predicted body weight), over higher tidal volumes (Vt>8 mL/kg). For mechanically ventilated adults with COVID-19 and ARDS, we recommend tar- geting plateau pressures (Pplat) of < 30 cm H2O. For mechanically ventilated adults with COVID-19 and moderate to severe ARDS, we s uggest using a higher PEEP strategy, over a lower PEEP strategy. Remarks: If using a higher PEEP strategy (i.e., PEEP > 10 cm H2O), clinicians should monitor patients for barotrauma. WEAK STRONG STRONG STRONG WEAK WEAK WEAK NONE BEST STRONG STRONG