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HickOnACrick

Are Adult ICU docs seeking your advice?

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During Covid-19, I have spent more time researching Adult pulmonary critical care than Neonatal pulmonary critical care. Based on this blog: https://emcrit.org/category/pulmcrit/ I am both fascinated and disgusted by the approach to respiratory support for Covid-19 patients. 

For those that have been following adult pulmonary critical care:

1. Are you appalled by the PEEP and PiPs?

2. Are you appalled by the FiO2s?

3. Do you feel like this is Neonatology circa 1990?

4. Do you think HFOV and/or NBCPAP are tools that should be applied earlier, not later for Covid-19 patients?

5. Do you have a hypothesis as to why neonates, who are inherently immunocompromised, are not more severely affected?

 

Thank you

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Thanks @HickOnACrick for posting about this, I sense it may become a hot topic :) 

Three of us ten neonatal consultants and one fellow too, are relocated from our NICU to the adult Covid-ICU. I recently spoke to one of them about how things were and he was also a bit surprised about high PEEPs/PIPs and the non-use of HFOV. He said that things are "just very different", but on the other hand, adults are different in many respects too.

I am myself just too far from adult care to have a good opinion, but it will be interesting to see how this discussion takes off.

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I queried one of my RTs this week, asking, "why are they not using HFOV as a lung protective strategy?" Essentially the answer was that HFOV is considered a rescue ventilator mode, and once they are on HFOV, they are calling for ECMO. The adult ICUs are using Vt of ~5mL/kg, but the PEEPs and PiPs to achieve that Vt is astonishing. 

Done properly, HFOV need not be a rescue therapy. With the increased focus on really good neonatal ventilators, especially those that can reliably provide volume-targeted support for babies < 1000g, I find myself using HFOV less and less. However, if my options were a PEEP of 20 (realistically 7 in neonate) or HFOV, I would opt for the HFOV every time. 

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