Management of Covid 19 pneumonitis (PCR confirmed or ... - …

1 Management of Covid -19 pneumonitis (PCR confirmed ; or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 1 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Contents This QRG provides a: Guideline for the Management of Covid -19 pneumonitis (PCR- confirmed ; or clinically suspected) requiring Non-invasive ventilation (NIV) or advanced respiratory support outside of ICU CPAP Initiation and weaning plan High Flow Oxygen initiation and weaning plan Supplementary notes provide prompts for the MDT Team to consider when managing patients on these pathways Group arrangements: Salford Royal NHS Foundation trust (SRFT) pennine acute Hospitals NHS trust (PAT) Management of Covid -19 pneumonitis (PCR confirmed .)

2 Or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 2 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Guideline for the Management of Covid -19 pneumonitis (PCR- confirmed ; or clinically suspected) requiring Non invasive ventilation (NIV) or advanced respiratory support outside of ICU NIV (CPAP/BiPAP) carries a significant AGP risk and should only be delivered in the following areas with full PPE in use Dedicated areas within ED, ITU, H1 (Medical high care unit) H2 (Respiratory ward), and Heart care unit O2 saturations <92% on >6litres oxygen (<88% in those at risk of hypercapnia)

3 And/or respiratory rate >25 and increased work of breathing Start medical treatment ASSESS CPR STATUS PO/IV Dexamethasone 6mg OD for 10 days HAT + VTE assessment If features of pneumonia consider antibiotics as per local trust guidelines S U / g g S swab Consider physiotherapy for trial of awake proning CONSIDER RECRUITMENT TO RECOVERY RS AT THIS STAGE If patient for full escalation then URGENTLY consider recruitment to RECOVERY-RS. If suitable, urgently contact 0161 206 2188 and inform ICU. If the patient is recruited then stop Pathway here and follow RECOVERY-RS pathway! RS0161 206 2188 Perform arterial blood gas relative contraindications to NIV Patient wishes F S 6 Poor prognosis / multiple comorbidities Treatment likely to cause distress Type 2 respiratory failure Urgent clarification of escalation status required.

4 S FT V :// k/ W /g ? = 31 0& = & = Type 1 respiratory failure Senior medical review.(ST3+) Careful patient selection, consultant involvement encouraged For level 3 care (Patient may deteriorate quickly) Contact critical care 68751 or vocera Increase fio2 Ensure fluid balance chart Consider physio Contact family ~Uncertain trajectory~ (may or may not be suitable for level 3) Discuss with Medical and ITU consultants as appropriate Apply continuous O2 Sats monitoring Start Oxygen therapy as tolerated by patient increase fio2 to target sats Ensure fluid balance chart Consider physio awake prone position Contact family Management of Covid -19 pneumonitis (PCR confirmed ; or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 3 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed ; or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 4 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed .)

5 Or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 5 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed ; or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 6 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed ; or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 7 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Management of Covid -19 pneumonitis (PCR confirmed .

6 Or clinically suspected) requiring Non-Invasive ventilation (NIV) or advanced respiratory support outside of ICU QRG Reference Number: QRGICU01(21) Version: 1 Issue Date: 08/01/2021 Page 8 of 8 It is your responsibility to check on the intranet that this printed copy is the latest version Document Control Information Lead Author and contact details: Waleed Salih Consultant Respiratory Physician 0161 206 2609 Sam Ford, Critical Care Medical Staff 0161 206 8753 Division/ Department: Respiratory Medicine/Critical Care Salford Care Organisation Parent Document: NA Applies to: Salford Care Organisation Approving Committee: Salford Care Organisation: Clinical Decision Group NCA Clinical Advisory Group Keywords: Covid -19, Non- Invasive Ventilation, Respiratory Support Date approved: 14/12/2020 Review date: December 2025