Opinion

Tracheostomy – Tracheotomy in ventilated patients with COVID-19: Guidelines from the COVID-19 Tracheotomy Task Force, a Working Group of the Airway SafetyCommittee of the University of Pennsylvania Health System, published in Annals of Surgery Indication – Tracheotomy may be considered in patients with prolonged periods of intubation, defined as greater than 21 days, who are otherwise without significant comorbidities and would be expected to have a good prognosis if recovery is achieved. Pre-Procedure – Rule out whether the patient is still positive or negative by performing PCR and/or CT chest. Informed consent must be obtained from NOK. LocationThe procedure should […]

The literature published from various countries has helped us to understand the disease pattern in COVID-19 pandemic. The New York experience Richardson et al. evaluated a large case series of 5,700 patients admitted to 12 hospitals under Northwell Health, the biggest health care provider in New York (1). They analyzed the clinical characteristics and outcomes of patients hospitalized over a 35-day period between March 1, 2020, and April 4, 2020. All patients tested positive for SARS-CoV-2 by RT-PCR on the nasopharyngeal sample. Patients were followed up until they were discharged alive or dead, or until the study endpoint. On April 4, […]

Recently there has been a growing interest in driving pressure as a significant parameter for titration in mechanical ventilation for ARDS patients. It has challenged our dogma of 6-8 mls/kg tidal volume ventilation. In this podcast, we discuss the current evidence and future of mechanical ventilation in ARDS.  Our understanding of mechanical ventilation in ARDS has evolved significantly since the year 2000. The key concepts that have been accepted in practice include low tidal volumes, low plateau pressure, lower driving pressures and reduced frequency of injurious strain cycles. The main focus is to avoid ventilator-associated lung injury. With the recent […]

Liberating high-risk patients from mechanical ventilation poses a unique challenge to all intensive care physicians. The use of high flow has increased over the last decade, however, the combination of high flow nasal oxygen and NIV has not been tested so far. The present study published in JAMA tries to answer this dilemma. Effect of Postextubation High-Flow Nasal Oxygen With Noninvasive Ventilation vs High-Flow Nasal Oxygen Alone on Reintubation Among Patients at High Risk of Extubation Failure: A Randomized Clinical Trial The decision regarding when to liberate patients from mechanical ventilation faces intensive care unit (ICU) clinicians regularly. While this […]