-
- Open airways using the 2Vs-2Es technique with a bag-valve-mask-reservoir device, coupled to an HEPA (High Efficiency Particulate Air) filter or to an HMEF (Heat and Moisture Exchange Filter) for an exceptional need for manual ventilation.1212. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia. [Internet] 2020 [cited 2020 Apr 14]. Available from: http://dx.doi.org/10.1111/anae.15054
http://dx.doi.org/10.1111/anae.15054...
-1313. Edelson DP, Sasson C, Chan PS, Atkins DL, Aziz K, Becker LB, et al. Interim Guidance for Basic and Advanced Life Support in adults, children, and neonates with suspected or confirmed COVID-19: from the Emergency Cardiovascular Care Committee and get with the Guidelines® - Resuscitation Adult and Pediatric Task Forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, The Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists: supporting organizations: American Association of Critical Care Nurses and National EMS Physicians. Circulation. [Internet] 2020 [cited 2020 Apr 19]. Available from: https://doi.org/10.1161/circulationaha.120.047463
https://doi.org/10.1161/circulationaha.1...
-
- Adhere to the use of N95, PFF2 or equivalent masks; beanie; goggles and/or face shield; procedure gloves and waterproof apron for aerosol-generating procedures.1414. Ferioli M, Cisternino C, Leo V, Pisani L, Palange P, Nava S. Protecting healthcare workers from SARS-CoV-2 infection: practical indications. Eur Respir Rev. [Internet] 2020 [cited 2020 May 4];29(155):200068. Available from: https://doi.org/10.1183/16000617.0068-2020
https://doi.org/10.1183/16000617.0068-20...
-
- Aspirate airway secretions with a closed suction system, when strictly necessary.
-
- Watch for signs of immediate need for tracheal intubation: SpO2 <93% with low-flow oxygen and/or respiratory rate >28 rpm or CO2 retention (PaCO2 >50 mmHg and/or pH <7.25).
-
- Auscultate lung sounds and assess chest radiography.
-
- Assist in the rapid sequence procedure of tracheal intubation and confirm position of the tracheal tube by continuous waveform capnography, when available.1212. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia. [Internet] 2020 [cited 2020 Apr 14]. Available from: http://dx.doi.org/10.1111/anae.15054
http://dx.doi.org/10.1111/anae.15054...
-
- Assess skin color, temperature, and moisture.
-
- Evaluate airway permeability and cough reflex.
-
- Evaluate the characteristics of the respiratory secretions and record them in the medical record.
-
- Evaluate ventilation mode and document parameters set on the mechanical ventilator in the medical record, in addition to variables such as driving pressure and plateau pressure.
-
- Assess serial level and arterial lactate clearance, when initial lactate (2 mmol/L.
-
- Assess response to the spontaneous breathing test (SBT).
-
- Assess whether the patient's breaths are synchronous with the mechanical ventilator.
-
- Calibrate the continuous oximetry of central or mixed venous oxygen saturation every 24 hours, when available.
-
- Clamp the tracheal tube with forceps (e.g., Reynald forceps) and pause ventilation with a mechanical ventilator in standby mode for maneuvering and disconnecting the airways.1212. Cook TM, El-Boghdadly K, McGuire B, McNarry AF, Patel A, Higgs A. Consensus guidelines for managing the airway in patients with COVID-19. Anaesthesia. [Internet] 2020 [cited 2020 Apr 14]. Available from: http://dx.doi.org/10.1111/anae.15054
http://dx.doi.org/10.1111/anae.15054...
,1515. Wang H, Zeng T, Wu X, Sun H. Holistic care for patients with severe coronavirus disease 2019: an expert consensus. Int J Nurs Sci. [Internet] 2020 [cited 2020 Apr 22];7(2):128134. Available from: https://doi.org/10.1016/j.ijnss.2020.03.010
https://doi.org/10.1016/j.ijnss.2020.03....
-
- Collect nasopharyngeal swab, sputum or endotracheal aspirate for laboratory exam.
-
- Collect arterial and/or central venous blood for blood gas analysis.
-
- Raise the head of the bed by 30-45(.
-
- Stimulate early mobilization in bed.1515. Wang H, Zeng T, Wu X, Sun H. Holistic care for patients with severe coronavirus disease 2019: an expert consensus. Int J Nurs Sci. [Internet] 2020 [cited 2020 Apr 22];7(2):128134. Available from: https://doi.org/10.1016/j.ijnss.2020.03.010
https://doi.org/10.1016/j.ijnss.2020.03....
-
- Avoid the administration of medications through nebulizations where there is no room with negative pressure.
-
- Provide supplemental oxygen through a nasal cannula (up to 5 L/min) or non-rebreathing face mask with reservoir (up to 10 L/min) for a target SpO2 (93%.16 16. Associação de Medicina Intensiva Brasileira. Recomendações da Associação de Medicina Intensiva Brasileira para a abordagem do COVID-19 em medicina intensiva [Internet]. 2020 Apr. São Paulo, SP(BR): AMIB; 2020 [cited 2020 Apr 22]. Available from: https://www.amib.org.br/fileadmin/user_upload/amib/2020/abril/13/Recomendaco__es_AMIB-atual.-16.04.pdf
https://www.amib.org.br/fileadmin/user_u...
-1717. World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance [Internet]. 2020 March. Geneva (CH): WHO; 2020 [cited 2020 Apr 22]. Available from: https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
https://www.who.int/publications-detail/...
-
- Establish standard precautions for droplets, contact and/or aerosols, as well as install1818. Akhtar MR, Ricketts W, Fotheringham T. Use of an antiviral filter attached to a pleural drain bottle to prevent aerosol contamination with SARS-CoV-2. Clin Med. 2 [Internet] 2020 [cited 2020 June 20];20(4):e60-1. Available from: https://doi.org/10.7861/clinmed.2020-0246
https://doi.org/10.7861/clinmed.2020-024...
an HEPA or HMEF filter in the vent port (breather) of chest drain bottles under water seal.
-
- Inflate the cuff with air to a pressure 25-30 cmH2O.1515. Wang H, Zeng T, Wu X, Sun H. Holistic care for patients with severe coronavirus disease 2019: an expert consensus. Int J Nurs Sci. [Internet] 2020 [cited 2020 Apr 22];7(2):128134. Available from: https://doi.org/10.1016/j.ijnss.2020.03.010
https://doi.org/10.1016/j.ijnss.2020.03....
-
- Investigate mottle/livedo reticularis on the skin and stage using the mottling score tool.
-
- Measure the patient's height to calculate the predicted tidal volume ((6 mL/kg).1919. Meng L, Qiu H, Wan L, Ai Y, Xue Z, Guo Q, et al. Intubation and ventilation amid the COVID-19 outbreak: Wuhan’s experience. Anesthesiology. [Internet] 2020 [cited 2020 Apr 30];132:1317-32. Available from: https://doi.org/10.1097/ALN.0000000000003296
https://doi.org/10.1097/ALN.000000000000...
-
- Monitor the peripheral oxygen saturation by pulse oximetry and communicate when SpO2 <93%.
-
- Monitor central or mixed venous oxygen saturation.
-
- Monitor CO2 levels at the end of expiration (EtCO2) by capnography.
-
- Position the enteral tube at post-pyloric level and check abdominal radiography.
-
- Prevent accidental extubation during decubitus changes, bed bath, change of artificial airway fixation, transport or mobilization for exams/procedures.
-
- Foresee and anticipate ventilatory weaning.
-
- Promote oral hygiene with an aqueous solution of 0.12% or 0.2% chlorhexidine digluconate every 12 hours, with previous application of 0.5% to 1% hydrogen peroxide or 0.2% povidone in the oral structures through embryo with gauze or mouthwash.2020. Ministério da Saúde (BR). Agência Nacional de Vigilância Sanitária. Nota Técnica GVIMS/GGTES/ANVISA nº 04/2020, de 31 de março de 2020. Orientações para serviços de saúde: medidas de prevenção e controle que devem ser adotadas durante a assistência aos casos suspeitos ou confirmados de infecção pelo novo coronavírus (SARS-CoV-2). Brasília, DF(BR): ANVISA; 2020 [cited 2020 Apr 22]. Available from: http://portal.anvisa.gov.br/documents/33852/271858/Nota+Técnica+n+04-2020+GVIMS-GGTES-ANVISA/ab598660-3de4-4f14-8e6f-b9341c196b28
http://portal.anvisa.gov.br/documents/33...
-
- Provide adequate sedation, analgesia and/or neuromuscular block in invasive ventilatory support.
-
- Perform patient pronation using the envelope maneuver and the three turning moments, with the participation of at least a physician, nurse, physiotherapist, and nursing technicians.2121. Oliveira VM, Piekala DM, Deponti GN, Batista DCR, Minossi SD, Chisté M, et al. Safe prone checklist: construction and implementation of a tool for performing the prone maneuver. Rev Bras Ter Intensiva. [Internet] 2017 [cited 2020 Mar 01];29(2):131-41. Available from: https://doi.org/10.5935/0103-507X.20170023
https://doi.org/10.5935/0103-507X.201700...
-
- Perform safe prone checklist by a bedside professional who is not involved in the maneuver.2121. Oliveira VM, Piekala DM, Deponti GN, Batista DCR, Minossi SD, Chisté M, et al. Safe prone checklist: construction and implementation of a tool for performing the prone maneuver. Rev Bras Ter Intensiva. [Internet] 2017 [cited 2020 Mar 01];29(2):131-41. Available from: https://doi.org/10.5935/0103-507X.20170023
https://doi.org/10.5935/0103-507X.201700...
-
- Perform scheduled extubation in agreement with the team and put a surgical mask on the patient.2222. D’Silva DF, McCulloch TJ, Lim JS, Smith SS, Carayannis D. Extubation of patients with COVID-19. Br J Anaesth. [Internet] 2020 [cited 2020 Apr 29];125(1):e192-5. Available from: https://doi.org/10.1016/j.bja.2020.03.016
https://doi.org/10.1016/j.bja.2020.03.01...
-
- Change mechanical fan circuits for visible dirt, damage or ventilation (30 days.
-
- Change the mechanical fan filter every 7 days for possible dirt, condensation or damage.
-
- Verify cuff pressure 4 times a day and before oral hygiene.