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Respiratory support in suspected COVID-19 patients. When conventional O2 therapy is not enough!
20 MarWe talk about evidences on respiratory support in the dyspneic and moderately/severe hypoxic suspect COVID-19 patient on the field. Clinical evidences and contamination risks in the potentially infected COV 19 patients to guide our efforts toward a good outcome when the conventional O2 therapy is not enough.
A step backward
The COVID-19 pneumonia. More than a “baby lung”
Clinical features and Imaging in early phases
Lung mechanics
Evidences of clinical features of OneLevel (CPAP) and BiLevel (BiPAP) respiratory support in massive epidemic crisis.
Not much of that. NIV in SARS and MERS epidemic demonstrated a poor outcome over invasive mechanical ventilation and possible delay effect on tracheal intubation and mechanical ventilation.
Clinical features OneLevel respiratory support
Clinical features BiLevel respiratory support
Risk benefits assessment
More risk patient level
More risk device level
Droplet spreading. OneLevel VS BiLevel respiratory support
Prehospital strategy and practical tips
When high flow conventional O2 therapy is not enough to reach clinical goals in the highly risk patient, non otherwise transportable and at risk of rapidly loosing airway patency One level PEEP respiratory support (CPAP) is the best compromise between clinical efficacy and contamination risk.
Ventilatory inspiratory support (BiPAP) doesn’t add much from a clinical point of view and increase the risk of contamination so has to be avoided.
Practical tips when using CPAP on the field
References
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