COVID-19 Daily: Noninvasive Ventilation Support, ‘Terrified’ in ICU

Noninvasive Ventilation Support Strategies

Hospitals have used various noninvasive ventilation techniques for patients with COVID-19 to stave off severe respiratory failure and ease pressure on scarce resources, but aerosolization and further spread of the virus is a potential risk. Clinical opinion is mixed. As the lead author of the European Society of Intensive Care Medicine’s guidelines . “we don’t know what the effect of these interventions on patient outcomes was.”

Refresher Courses

For clinicians who may be called to provide care for COVID-19 patients outside their area of expertise, the American Heart Association, the American Association for Respiratory Care, and the American Society of Anesthesiologists have developed four training modules on the basics of oxygenation and ventilation management for COVID-19 patients.

Inside a COVID-19 ICU

Even for an ICU nurse with a 30-year career, COVID-19 is like nothing she’s seen before. Her hospital’s 12-bed ICU has more than doubled in size and houses 21 COVID-19 patients on mechanical ventilators. Families can’t be with their loved ones as they decline. The hospital is short on PPE, and has drafted less experienced nurses to work in the ICU with an 8-hour crash course in critical care nursing. 

“It’s hard to explain to the newer nurses how unusual this all is and why we are having problems keeping [the COVID-19 patients] stable,” said the nurse, on the condition of anonymity and asked that her community hospital in the northeastern United States not be identified. “To be able to keep going, I have to forgive myself that I’m not going to be the ICU nurse I was before COVID… I do the best I can with what I have.”

“I’m terrified,” she said.

A Variety of Tests

The US Food and Drug Administration (FDA) has approved nearly two dozen tests for SARS-CoV-2, but challenges such as specimen quality, availability of reagents, and testing backlogs remain. And the clinical performance of tests approved under the FDA’s Emergency Use Authorization, which doesn’t require clinical studies, is unknown. “Based on what we know about influenza, it’s unlikely that all of these tests are going to perform exactly the same way,” one expert said. 

African Americans Disproportionately Affected

In Milwaukee, Wisconsin, nearly half of the county’s 945 COVID-19 cases and the majority of its 27 deaths were African Americans, as of Friday. Milwaukee county is 26% Black. This pattern is also appearing in the other few places in the United States tracking racial demographics of people with COVID-19, ProPublica reports. “COVID is just unmasking the deep disinvestment in our communities, the historical injustices and the impact of residential segregation,” said a family physician and epidemiologist who worked at the CDC for 13 years.

Intubation Boxes

Given PPE shortages at many hospitals, clinicians performing aerosol-generating procedures such as intubation are improvising extra protection: transparent plastic boxes that cover a patient’s head, with holes for the clinician’s hands. Physicians at Boston Medical Center and Brigham and Women’s Hospital simulated intubation procedures in which the “patient” (an airway mannequin) coughed fluorescent dye, and found no contamination outside the box when examining the clinician who performed the procedure and the room with ultraviolet light. Hospitals can get similar boxes for free from Klick Health.

In Memoriam

As front-line healthcare workers care for patients with COVID-19, they commit themselves to difficult, draining work and also put themselves at risk for infection. Hundreds throughout the world have died.