Zhang et al. 2020 Ketamine has both sedative- and analgesic-sparing properties, Consider use in patients requiring high dose continuous infusion propofol, or any continuous benzodiazepines, to decrease or eliminate benzodiazepine requirements, Initiate at 0.1mg/kg/hr; do not exceed 1.2mg/kg/min as this is when patients begin to dissociate (higher doses may be used to treat refractory status epilepticus, status asthmaticus, or in patients failing high doses of propofol/benzodiazepines and requiring paralytics) Ketamine is unlikely to replace benzodiazepines when using for vent synchrony. (3)Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois. A significant response is defined as a SaO2 of 88-92% with at least a 10% absolute reduction in FiO2 (i.e. 3. Consider high flow nasal cannula (HFNC) with surgical mask to reduce aerosol if requiring NRB or escalating pendant. Liang et al. There is no medical literature to guide the management of sarcoidosis patients with COVID-19. However, medical adaptations and advancements have led to increased adult usage and Aly El Banayosy, M.D. If the patient remains hypoxic with infiltrates with a Hb > 7.0 g/dl, proceed to exchange transfusion. These recommendations aim to balance the risk of a patient being harmed by nosocomial infections, including novel coronavirus, and being harmed by late-detection of a potential cancer that might reduce the chance of cure. In patients with moderate to severe liver dysfunction consider enteral dose reductions of 25%-50%, Severe ARDS in accordance with Berlin criteria, but specifically defined as: PaO2:FiO2 < 150 after at least 12 hours of mechanical ventilation using FiO2 > 0.6 and PEEP > 5, Ventilator dys-synchrony causing high plateau pressures (>30cm H2O) or injurious tidal volumes (TV >8cc/kg IBW), Ventilator dys-synchrony causing hypoxemia, Administer single IV push dose of paralytic, with dosing detailed below in specific medications-NMB, Assess for clinical effect at 30-60 minutes after administration of paralytic, If favorable response (i.e., a safer plateau pressure or tidal volumes, improved oxygenation), then proceed to step 3, If no obvious response, then proceed to step 4, Continue to reassess patient-ventilator synchrony and oxygenation, If sustained improvement, repeat IV push dosing q6-8 hours as detailed in specific medications-NMB, If ventilator dys-synchrony recurs. Patients with hypertension and diabetes are at increased risk for COVID-19 (Guan et al.) Currently, the following PAH medications are available on BMC formulary: Oral sildenafil, tadalafil and ambrisentan, Traditionally, these medications would need to be brought from home for inpatients but if policies do not allow this, the PH consult service will assist with working with BMC pharmacy to acquire them, We do not anticipate any medication shortages and each pharmaceutical company in the PAH world has ensured this, All specialty pharmacies (Accredo, CVS Caremark, etc) are fully operational and remain the point of contact for medication related issues, Sildenafil is under investigation as a potential COVID-19 therapeutic. While the majority of studies assessing benefit of NMB in ARDS use a continuous infusion strategy, the medication shortages occurring due to the COVID-19 pandemic requires an approach that also considers maximizing our medication supply. BMC Airway and Oxygenation Guidelines When substituted for a nebulizer treatment, the dose of albuterol MDI is 4 to 8 inhalations, administered as separate inhalations with a valved holding chamber. It complicates routine vent FiO2 changes, so recommend only for life-threatening hypoxemia, e.g., consider if P/F <100, strongly consider if P/F<60. • Patients with asthma exacerbations who may need more than nasal cannula support should have MICU consultation. Evidence suggests that a subgroup of patients with severe COVID-19 develop increased inflammation that often precedes clinical decline. Graduates of the Pediatric Critical Care Medicine Fellowship at MassGeneral Hospital for Children/Harvard Medical School have become expert practitioners and leaders in the field of Pediatric Critical Care Medicine. surgery will impact treatment), Patients unlikely to separate from mechanical ventilation or likely to have prolonged ICU needs (i.e. All other anti-viral and immunomodulatory directed therapies are EXPERIMENTAL and based on pre-clinical data, expert opinion, small and emerging clinical studies and consensus statements. It is an exciting and dynamic unit. A subset of patients with severe disease from COVID-19 may benefit from NMB. adjunctive therapy designed to improve oxygenation. #1 Ranked Children’s Hospital by. Communication is crucial to the successful delivery of safe and effective clinical services. Consult is mandatory on all COVID-19 SCD patients admitted to ICU. The ECMO Program is housed within the hospital's Medical-Surgical Intensive Care Unit. Most non-small cell lung cancers (NSCLC) have a doubling time of approximately 3-6 months, though a subset may have much faster progression. Encourage the transition of routine and urgent clinic visits for asthma management to televisits. Virginia S. Kharasch, MD† 1. Phuong Vo, MD* 2. Please contact Rob Elloyan, If you become sick for for any reason feel you cannot work an assigned shift, please active the backup system by contacting Felicia Chen (faculty), Chris Reardon (fellows), or the chief residents (house staff). Latest updates and information on BU 's response to lorazepam nurse teaching patients. For physical distancing needed for infection control measures should be abided by will continue to support the use these... Pulmonary and Allergy, Boston Medical Center MICU and Pulmonary COVID-19 BEST PRACTICES Tweets by BMCimRES extubation to facilitate successful... Boston Children 's Health, Karolinska Institute, Stockholm, Sweden only 15 minutes long one! 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