COVID-19 Ventilation Protocol

Adapted from an algorithm developed by The Toronto Centre of Excellence in Mechanical Ventilation (CoEMV)

Questions

1.I understand that this protocol was developed by the Toronto Center of Excellence in Mechanical Ventilation (CoEMV) and should not be used alone to guide patient care, nor should it replace clinical judgment.
2.Indication for Intubation?
3.Assess For Recruitability

About

This tool provides guidance for initial ventilation management in COVID-19 patients. It is based on an algorithm developed by The Toronto Centre of Excellence in Mechanical Ventilation (CoEMV).

The Toronto CoEMV recommends managing COVID-19 patients based on recruitability.

Non-Recruitable: Recommend low PEEP (10 or even lower) and prone positioning if PaO₂/FiO₂ is ≤150 mmHg.

Note: Prone positioning of the patient is recommended in order to protect the patient's lungs. The process is lengthy, and patience is required to see improvement in oxygenation which may take hours. Consider ECMO if the PaO₂/FiO₂ is consistently below 80. If resources are not available, any other rescue strategy such as inhaled nitric oxide could buy more time. Avoid 100% FiO₂, which favors de-nitrogenation atelectasis. 90%, 80%, or 70% would be better. The difference between 100% and 70%-90% may not drastically change oxygenation in the blood due to a high shunt fraction.

Recruitable: Recommend high levels of PEEP. These patients would still benefit from prone positioning if the PaO₂/FiO₂ ratio remains ≤150 mmHg.

Please see the calculator "Inflation to Recruitment Ratio" for more information on how to assess a patient's recruitability.

References

Chen, Lu, et al.

Potential for Lung Recruitment Estimated by the Recruitment-to-Inflation Ratio in Acute Respiratory Distress Syndrome. A Clinical Trial.

American Journal of Respiratory and Critical Care Medicine 2020 January 15, 201 (2): 178-187.

Piraino, Thomas, and Laurent Brochard.

COVID-19 Message to Respiratory Therapists.

The Toronto Centre of Excellence in Mechanical Ventilation, 2020.

The COVID-19 Ventilation Protocol calculator is created by QxMD.

Created by on 09/04/2020

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1. I understand that this protocol was developed by the Toronto Center of Excellence in Mechanical Ventilation (CoEMV) and should not be used alone to guide patient care, nor should it replace clinical judgment.

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