Covid 19 Airway Management And Ventilation Strategy For Critically Ill Older Patients

This book describes the issues and challenges that clinicians encountered in the management of older critically ill patients during the Covid-19 pandemic, and offers practical information on how to manage them. Older adults are more susceptible to complications such as acute respiratory distress syndrome (ARDS) as a result of viral pneumonia. In addition, they often have multiple comorbidities and are commonly frail, which means their various organs and systems, such as the respiratory system, have reduced functional reserves. As such, older adults are less able to react to acute stressors. During the current Covid-19 pandemic, older adult patients' mortality is increased. Further, the infection and death rates of elderly people in nursing homes and health care institutions are high. Management of older adults with Covid is complicated. The reduced availability of beds may limit their access to ICU. Moreover, the prognosis may be poor, and airway management and ventilation strategies have to take into account various clinical and physiological characteristics specific to older patients. This book is addressed to all allied professionals involved in the management of older critically ill patients and presents information collected and practical lessons learned from the clinical daily management of this population during the pandemic.

This book provides healthcare professionals in Critical Care setting an easy consultation guide to fight against COVID-19. The book is divided into sections: Fundamentals of COVID-19, Pneumological critical care, Neurological manifestations, Cardiovascular manifestations, Renal manifestations, Haemostasis and coagulation, Other multi-organs involvement, Principles of therapy. Each section includes: · brief pathophysiology of COVID-19 (ventilation, neurological, cardiovascular, etc.); · principles of management (enriched with flowcharts and figures); · principles of therapy; · tips and key messages. Readers can find the most updated advices on how to face the ongoing pandemic: from principles of conventional oxygen therapy, assisted and invasive mechanical ventilation in critically ill COVID-19 patients to the complications sometimes underestimated. Tables and flowcharts provided are based on current knowledge in COVID-19 to help the clinician managing COVID-19 patients by a multiple-organs prospective. Written by international key opinion leaders of each field, the book represents a point of reference for all professionals involved in the management of COVID-19 pandemic.

Abstract: During the COVID-19 pandemic, large numbers of elderly, multimorbid people required treatment in intensive care units. This study investigated how the inherent patient factors age and comorbidity burden affected the treatment strategy and the outcome achieved. Retrospective analysis of data from intensive care patients enrolled in the Lean European Open Survey on SARS-CoV2-Infected Patients (LEOSS) cohort found that a patient's age and comorbidity burden in fact influenced their mortality rate and the use of ventilation therapy. Evidence showed that advanced age and multimorbidity were associated with the restrictive use of invasive ventilation therapies, particularly ECMO. Geriatric patients with a high comorbidity burden were clustered in the sub-cohort of non-ventilated ICU patients characterized by a high mortality rate. The risk of death generally increased with older age and accumulating comorbidity burden. Here, the more aggressive an applied procedure, the younger the age in which a majority of patients died. Clearly, geriatric, multimorbid COVID-19 patients benefit less from invasive ventilation therapies. This implies the need for a holistic approach to therapy decisions, taking into account the patient's wishes

This book is the first to describe a practical evidence-based approach to the management of critically ill obese patients with various medical or postoperative respiratory problems in the intensive care unit. In brief, the book aims to identify the best strategy and present clinical recommendations for different circumstances, to establish indications for and contraindications to noninvasive and invasive mechanical ventilation, and to offer clear guidance on weaning from mechanical ventilation and on respiratory care. Causes of acute respiratory failure in the obese patient are discussed, and advice is offered on the prevention and management of complications during mechanical ventilation and on moving and feeding critically ill obese patients. Long-term outcomes, ethical issues, and health care costs are also addressed. The multidisciplinary approach, with contributions from international experts in different specialties, ensures that the book will be of interest to a range of health professionals involved in critical care, including intensivists, anesthesiologists, and pulmonologists.

"Hypoxaemia is a major contributor to child deaths that occur worldwide each year; for a child with pneumonia hypoxaemia increases the risk of death by up to 5 times. Despite its importance in virtually all types of acute severe illness, hypoxaemia is often not well recognized or well managed, more so in settings where resources are limited. Oxygen therapy remains an inaccessible luxury for a large proportion of severely ill children admitted to hospitals in developing countries. This is particularly true for patients in small district hospitals, where, even if some facility for delivering oxygen is available, supplies are often unreliable and the benefits of treatment may be diminished by poorly maintained, inappropriate equipment or poorly trained staff with inadequate guidelines. Increasing awareness of these problems is likely to have considerable clinical and public health benefits in the care of severely ill children. Health workers should be able to know the clinical signs that suggest the presence of hypoxaemia and have more reliable means of detection of hypoxeamia. This can be achieved through more widespread use of pulse oximetry, which is a non-invasive measure of arterial oxygen saturation. At the same time oxygen therapy must be more widely available; in many remote settings, this can be achieved by use of oxygen concentrators, which can run on regular or alternative sources of power. Having effective systems for the detection and management of hypoxaemia are vital in reducing mortality from pneumonia and other severe acute illnesses. Oxygen therapy is essential to counter hypoxaemia and many times is the difference between life and death. This manual focuses on the availability and clinical use of oxygen therapy in children in health facilities by providing the practical aspects for health workers, biomedical engineers, and administrators. It addresses the need for appropriate detection of hypoxaemia, use of pulse oximetry, clinical use of oxygen and delivery systems and monitoring of patients on oxygen therapy. In addition, the manual addresses practical use of pulse oximetry, and oxygen concentrators and cylinders in an effort to improve oxygen systems worldwide."--Publisher's description.

Disasters and public health emergencies can stress health care systems to the breaking point and disrupt delivery of vital medical services. During such crises, hospitals and long-term care facilities may be without power; trained staff, ambulances, medical supplies and beds could be in short supply; and alternate care facilities may need to be used. Planning for these situations is necessary to provide the best possible health care during a crisis and, if needed, equitably allocate scarce resources. Crisis Standards of Care: A Toolkit for Indicators and Triggers examines indicators and triggers that guide the implementation of crisis standards of care and provides a discussion toolkit to help stakeholders establish indicators and triggers for their own communities. Together, indicators and triggers help guide operational decision making about providing care during public health and medical emergencies and disasters. Indicators and triggers represent the information and actions taken at specific thresholds that guide incident recognition, response, and recovery. This report discusses indicators and triggers for both a slow onset scenario, such as pandemic influenza, and a no-notice scenario, such as an earthquake. Crisis Standards of Care features discussion toolkits customized to help various stakeholders develop indicators and triggers for their own organizations, agencies, and jurisdictions. The toolkit contains scenarios, key questions, and examples of indicators, triggers, and tactics to help promote discussion. In addition to common elements designed to facilitate integrated planning, the toolkit contains chapters specifically customized for emergency management, public health, emergency medical services, hospital and acute care, and out-of-hospital care.

The Difficult Airway provides a comprehensive textual and visual coverage of how to deal with patients who have expected or unexpected difficult airways. The text begins with a description of the incidence and importance of the difficult airway and then describes the ASA Difficult Airway Algorithm created to facilitate the management of “difficult airways.” The majority of the book features a comprehensive step-by-step approach to the rescue techniques listed as part of the ASA Algorithm. Noted experts in each of the techniques have been recruited by the book editors to present the information. Figures throughout the book illustrate important points and procedures. This is a wonderful resource for professionals in the health care field including anesthesiologists, intensive care physicians, emergency room physicians, nurses, and out-of-hospital first responders.

This book provides a concise yet comprehensive overview of pediatric acute respiratory distress syndrome (PARDS). The text reviews the emerging science behind the new PARDS definition; explores epidemiology, pathobiology, etiologies, and risk factors; reviews state-of-the-art treatment modalities and strategies; and discusses clinical outcomes. Written by experts in the field, Pediatric Acute Respiratory Distress Syndrome: A Clinical Guide is a valuable resource for clinicians and practitioners who specialize in pediatric critical care.

This book, part of the European Society of Intensive Care Medicine textbook series, teaches readers how to use hemodynamic monitoring, an essential skill for today’s intensivists. It offers a valuable guide for beginners, as well as for experienced intensivists who want to hone their skills, helping both groups detect an inadequacy of perfusion and make the right choices to achieve the main goal of hemodynamic monitoring in the critically ill, i.e., to correctly assess the cardiovascular system and its response to tissue oxygen demands. The book is divided into distinguished sections: from physiology to pathophysiology; clinical assessment and measurements; and clinical practice achievements including techniques, the basic goals in clinical practice as well as the more appropriate hemodynamic therapy to be applied in different conditions. All chapters use a learning-oriented style, with practical examples, key points and take home messages, helping readers quickly absorb the content and, at the same time, apply what they have learned in the clinical setting. The European Society of Intensive Care Medicine has developed the Lessons from the ICU series with the vision of providing focused and state-of-the-art overviews of central topics in Intensive Care and optimal resources for clinicians working in Intensive Care.

The second edition of this book describes the clinical indications of NIV in patients hospitalized with high-risk infections as well as in the prehospital management of mass casualty incidents, including chemical or biological disasters and pandemics. In recent decades, we have learned the impact that different pandemics and mass casualty disasters can outcome in terms of health resource use, health costs and human lives. The development of respiratory failure in these patients, either infectious or non-infectious causes, has led to develop employment plans related both to invasive or noninvasive mechanical ventilation during acute respiratory failure. In this book authors evaluate a rational basis for indications, specific noninvasive mechanical ventilation indications in hospitalized patients (tuberculosis, bacterial, virus, etc.) and prehospital applications (mass casualty: chemical, biological disaster), equipment (ventilators, interfaces) and plan organization for health systems: how and when apply NIV. A critical review of already published studies is described as well as implications and how will be the future according to international expert opinions. Therefore, this updated edition represents a useful scientific reference point according to what it has been experienced in the last pandemics, with respect to the growing role that NIV has and must have in the world.