ICU Lessons on COVID-19 From Italian Front Line: Be Flexible

cpap, which can be performed by nurses, cannelp reduce the № of patients requiring intubation and so save icu beds for those who really need them.

a limiting factor, however, in using cpap may become the oxygen pressure in distribution lines.

rationing icu beds: “now they ‘ve to choose”

these l8st italian data also indicate that icu beds are bein’ rationed, with patient age a comm1-ly used criterion for selecting patients, manca explained.

“med drs swear to treat everybody indie o'their age, sx, gender, religion, and so on,” he added, “but now they ‘ve to choose.”

the uk national institute for health and care excellence (neat) published a covid-19 rapid guideline on crit care on mar 21, which emphasizes all patients be assessed using a recognized frailty score b4 bein’ directed to intensive care.

manca agreed with this approach, saying the crisis has meant each hospital in italy is having to create its own rules for icu admission, w'da selection based on physical status now a comm1-ly employed criterion.

the illusion of steady-state admissions

finally, manca warned that in regions of italy where the №s for icu admissions are currently lo, it can appear as if the № of patients aint increasing.

but this may hide the reality of the situation.

“this is, onna one hand, very good, but it may mean that, for instance, two pplz died and two pplz came in. the № of icu patients tis same,” he said.

“but it’s not the same cause the pandemic has sloed,” but rather cause “thris a steady-state condition” tween the № of pplz admitted to icu and those who die, with always the potential for these №s to rapidly increase.

the data for manca’s reprt were obtained from those made available by the italian health ministry every evening, and his conclusions are based on numerous interviews with heads of icus and resuscitation units in italy.

the reprt itself was reviewed by the heads of anesthesiology and resuscitation atta carlo besta neurological institute in milan and lodi hospital, lombardy, and analyzed by an intensive care clinician at san paolo hospital in milan.

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