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


CPAP, which might be carried out by nurses, can assist cut back the variety of sufferers requiring intubation and so save ICU beds for individuals who really want them.

A limiting issue, nevertheless, in utilizing CPAP might turn into the oxygen strain in distribution strains.

Rationing ICU Beds: “Now They Have to Choose”

These newest Italian information additionally point out that ICU beds are being rationed, with affected person age a generally used criterion for choosing sufferers, Manca defined.

“Medical doctors swear to treat everybody independent of their age, sex, gender, religion, and so on,” he added, “but now they have to choose.”

The UK National Institute for Health and Care Excellence (NICE) revealed a COVID-19 rapid guideline on important care on March 21, which emphasizes all sufferers be assessed utilizing a acknowledged frailty rating earlier than being directed to intensive care.

Manca agreed with this method, saying the disaster has meant every hospital in Italy is having to create its personal guidelines for ICU admission, with the choice based mostly on bodily standing now a generally employed criterion.

The Illusion of Steady-State Admissions

Finally, Manca warned that in areas of Italy the place the numbers for ICU admissions are presently low, it may possibly seem as if the variety of sufferers is just not growing.

But this will cover the fact of the state of affairs.

“This is, on the one hand, very good, but it may mean that, for instance, two people died and two people came in. The number of ICU patients is the same,” he mentioned.

“But it’s not the same because the pandemic has slowed,” however reasonably as a result of “there is a steady-state condition” between the variety of individuals admitted to ICU and those that die, with at all times the potential for these numbers to quickly enhance.

The information for Manca’s report have been obtained from these made obtainable by the Italian Health Ministry each night, and his conclusions are based mostly on quite a few interviews with heads of ICUs and resuscitation items in Italy.

The report itself was reviewed by the heads of anesthesiology and resuscitation on the 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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