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

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CPAP, which can be performed by nurses, can help reduce the number of patients requiring intubation and so save ICU beds for those who really need them.

A limiting factor, however, in using CPAP may become the oxygen pressure in distribution lines.


Rationing ICU Beds: “Now They Have to Choose”

These latest Italian data also indicate that ICU beds are being rationed, with patient age a commonly used criterion for selecting patients, Manca explained.

“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) published a COVID-19 rapid guideline on critical care on March 21, which emphasizes all patients be assessed using a recognized frailty score before being directed to intensive care.

Manca agreed with this approach, saying the crisis has meant each hospital in Italy is having to create its own rules for ICU admission, with the selection based on physical status now a commonly employed criterion.


The Illusion of Steady-State Admissions

Finally, Manca warned that in regions of Italy where the numbers for ICU admissions are currently low, it can appear as if the number of patients is not increasing.

But this may hide the reality of the situation.

“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 said.

“But it’s not the same because the pandemic has slowed,” but rather because “there is a steady-state condition” between the number of people admitted to ICU and those who die, with always the potential for these numbers to rapidly increase.

The data for Manca’s report were obtained from those made available by the Italian Health Ministry every evening, and his conclusions are based on numerous interviews with heads of ICUs and resuscitation units in Italy.

The report itself was reviewed by the heads of anesthesiology and resuscitation at 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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Key Drugs Join PPEs on List of Front-Line Shortages

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What your doctor is reading on Medscape.com:

APRIL 02, 2020 — First it was a critical shortage of personal protective equipment. Then pleas for more ventilators to sustain patients with COVID-19 and providers to care for them. Now, multiple sources are reporting deepening shortages of the drugs needed to help ventilate patients and keep them sedated.

Shortages are already evident for albuterol; neuromuscular blockers and sedatives, including fentanyl, midazolam, and propofol; and vasopressors for septic shock, even as orders increase exponentially.

The rates at which hospitals traditionally had been able to fill orders for ventilator-associated drugs was 95%, Dan Kistner, PharmD, told Medscape Medical News

“These classes of drugs have dropped to 60 or 70% in the last month alone,” said Kistner, senior vice president for pharmacy solutions at Vizient, a group purchasing organization that negotiates medicine contracts for about 3000 hospitals and healthcare facilities in the US.

“Every day it’s dropping 2 or 3 additional percent,” he continued.


Demand “Unprecedented”

The demand is simply “unprecedented,” he said, adding that the shortages are piling up even after elective surgeries have been put on hold.

A California nurse’s tweet in a nationwide thread of tweets under #WeNeedMeds poignantly described the consequences of severe shortages of some of these drugs. “Please do not put me on a vent if you can’t keep me sedated,” she writes. “I understand the alternative is death.”

Esther Choo, MD, MPH, an emergency physician at Oregon Health &  Science University in Portland, tweeted: “Those ventilators can’t really be used without a similarly vast supply of coupled medications to get people *on* the vents — and keep them on humanely. Hospitals are already experiencing shortages, before we even hit disease apex.”


15 Drugs at or Near Short Supply

Healthcare improvement company Premier, based in Charlotte, North Carolina, this week released a report that found 15 drugs used for COVID-19 care are in shortage or close to being in short supply at the same time demand is skyrocketing, particularly in New York.

Their data differ slightly from Vizient’s but still show increasing numbers of orders going unfilled.





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What a great live class with @tracyandersonmethod and @anneclaire.nelson today!!…

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What a great live class with @tracyandersonmethod and @anneclaire.nelson today!! So much energy and realness at real time! The balancing moves with the chair and broom stick are so nostalgic (and really challenging!). I love it when I forget about myself for being so concentrated and into the workout – “runner’s high” or “Tracy’s high” as you might call it! And love love love her little outdoor studio in Florida 🌴 makes this entire crazy situation feel more special, I guess in a couple of years we will say “remember that time Tracy used to teach outdoor under palm trees”? It will make reframing this situation into a positive phase in our lives much easier! Enjoyed every second of it! @tracyandersononlinestudio #tracyandersonmethod #tracyandersonforlife #outdoorworkout #homeworkout #stayhomestayactive



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Health Minister Zweli Mkhize media briefing on COVID-19: 01 April 2020

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MINISTER OF HEALTH LAUNCHES COVID-19 MOBILE SAMPLING AND TESTING UNITS. In light of the increasing incidence of COVID-19 local transmissions, it has become necessary to scale up the capacity of testing citizens across the country. To this end The National Health Laboratory service has procured 60 mobile sampling and testing units to be deployed nationwide to all districts and metropolitan municipalities. The Minister of Health, Dr Zweli Mkhize, will be launching and showcasing these mobile testing units at the NHLS

For more news, visit sabcnews.com and also #SABCNews on Social Media.

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