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I don’t know if other people have had a similar experience but at my 3 hospitals we haven’t had much success in getting COVID pts extubated in the second surge. Some got trached ; some maybe have gone to LTACH but nobody got extubated and did well. Is it because we keep people on vapotherm / Bipap much more than we would keep the regular ARDS pt and they develop barotrauma ?
I remember in the first surge I had pts who were on 12- 15 L and I didnt sit on them for days. I intubated and did standard ARDS management with prone/ paralysis as needed and few days later they came off vent and actually discharged on RA. But I don’t see that in the 2nd surge. And I see a lot more PTX and pneumomediastinum now.
What is the prognosis for someone > 60 yrs who spent 3-4 days on 90-100 % vapotherm or Bipap and then got bad enough to need intubation ?
I remember in the first surge I had pts who were on 12- 15 L and I didnt sit on them for days. I intubated and did standard ARDS management with prone/ paralysis as needed and few days later they came off vent and actually discharged on RA. But I don’t see that in the 2nd surge. And I see a lot more PTX and pneumomediastinum now.
What is the prognosis for someone > 60 yrs who spent 3-4 days on 90-100 % vapotherm or Bipap and then got bad enough to need intubation ?