Knowledge Translation Tools to Guide Care of Non-Intubated Patients With Acute Respiratory Illness During the COVID-19 Pandemic

David Leasa; Paul Cameron; Kimia Honarmand; Tina Mele; Karen J. Bosma

Disclosures

Crit Care. 2021;25(22) 

In This Article

Preventing Hospital Transmission of COVID-19 Through Isolation and Ppe

To reduce hospital transmission, environmental control and appropriate PPE must be considered when managing patients. Suspected or confirmed COVID-19 patients requiring hospital admission and undergoing AGMPs should be admitted to a negative pressure room, if available, otherwise, single-patient rooms (with door closed). Negative pressure rooms within the Emergency Department or ICU may be reserved for patients requiring ETI on arrival, as the intubation procedure is a high-risk AGMP. Rapid sequence intubation should be performed by the most experienced person with a limited number of HCPs in the room.[1,2,47] Where available, specialized "intubation teams" of highly experienced HCPs may perform all intubations in COVID-19 suspect/confirmed cases.[47,48] A hydrophobic filter should be interposed between the facemask and breathing circuit. After the intubation procedure is complete, patients receiving invasive mechanical ventilation through a closed circuit may be moved out of negative pressure rooms and cohorted according to COVID-19 status. The number of air exchanges per hour in the room will determine the length of time to clear the air of aerosolized particles after completion of an AGMP within the room.

If a patient develops symptoms suggestive of COVID-19 while in hospital, the patient should be transferred to a single patient or negative pressure room for AGMP with appropriate PPE used. CT scan may improve diagnostic sensitivity, particularly in the early phase of infection where nasopharyngeal swab PCR may be falsely negative.[49] If test results confirm the patient is COVID-19 negative, no further action is needed. The area(s) will need thorough cleaning as the virus does survive on stainless steel and plastic for up to 48 h.[16]

Detailed guidelines for PPE required during AGMPs and recommendations for optimizing the supply of PPE during the COVID-19 pandemic are available.[17,50,51,52] As described by Lockhart et al.,[17] we recommend a three-tiered approach to PPE, as shown in Figure 1b. Care with donning and doffing of PPE is crucial and should be reviewed in instructional videos[53] and practiced under supervision.

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