Great achievements

Know a patient who is a COVID survivor. He was in the ICU for a month, requiring mechanical ventilation for almost four weeks. That’s much longer than a typical patient with bacterial pneumonia. This patient required a lengthy infusion of the neuromuscular blockade which, along with shock, contributed to the profound weakness. This complication is also called critical illness polyneuropathy. *What can we do during these 4 weeks when the patient is paralyzed to minimize the myopathy and neuropathy that may develop? *Are there treatments or therapies? *Are you familiar with the concept of Disease tolerance and Adaptogens? I’d love to hear others’ reflections on this and if you have any tips for preparation

Doctors report that, placing the patients on their stomachs improved their oxygen saturation levels. This technique had also proved to improve the oxygen supply to the lungs. By placing in such way the parts of lungs are opened up which are not so before. A study conducted in the year 2013, also proved the same: Prone positioning is not a new technique it has been used for many years in improving the oxygen saturation in acute respiratory distress syndrome (ARDS) patients those requiring mechanical ventilation. Controlled trials have confirmed that oxygenation is significantly better when patients are in the prone position than when they are in the supine position. Several evidences had shown that prone positioning could prevent ventilator-induced lung injury. The studies have also confirmed that there was significant improved with prone positioning as compared with supine positioning among patients with severely hypoxemic ARDS at the time of randomization. “Lying face down was in some cases more helpful than applying positive pressure in the lungs using ventilators in COVID-19 patients.” Another recent study claims this. It indicates that some patients do not respond well to high positive pressure and respond better to prone positioning in bed. Researchers in the US are now looking at the effects of turning patients who need extra oxygen — but not necessarily a ventilator — on their stomachs, as part of clinical trials. NOTE: Hence, flipping COVID-19 patients onto their stomachs, or “prone positioning,” is an effective way to keep them alive in intensive care.

Patient in early 50s who has a history of SARS when it was going round. Presents with shortness of breath, oxygen saturation in high 80s despite no chronic pulmonary disease. The patient seems to be coping well, but when do you decide to proceed to intubation assuming this is COVID-19? Watch and observe until they begin to deteriorate, or intubate while still well?

#ItsTime A 56 y/o male with diarrhea & breathlessness. Lung auscultation revealed diffuse rhonchi and decreased breath sounds on the right side. He was afebrile and had increasing low to normal wbc in the prior 3 days (2.6–6.0 × 109/L). Chest X-ray showed diffuse consolidation throughout the right lung consistent with pneumonia. Is it tb?

This patient was admitted to the ICU with COVID pneumonia a few weeks ago and due to a very high D-dimer level, empiric anticoagulation was initiated. The night prior to extubation, the patient's oxygen saturation plummeted, fresh blood appeared in the ventilator tubing, and the second X-ray was obtained.