COVID-19 Curbside Consults

Respiratory failure in patients infected with SARS-CoV-2

Rishik Vashisht, MD and Abhijit Duggal, MD, MPH, MSc
Cleveland Clinic Journal of Medicine August 2020, DOI: https://doi.org/10.3949/ccjm.87a.ccc025

Article Figures & Data

Tables

  • TABLE 1

    A high-PEEP, low Fio2 strategy

    Fio2PEEP
    0.3 5
    0.3 8
    0.310
    0.312
    0.314
    0.416
    0.416
    0.518
    0.518
    0.5–0.820
    0.822
    0.922
    1.022
    1.024

    • Use a minimum positive end-expiratory pressure (PEEP) of 5 cm H2O. Consider using incremental combinations of fraction of inspired oxygen Fio2 and PEEP as shown to achieve PaO2 of 5–80 mm Hg or SpO2 88%–95%.

    • From the Acute Respiratory Distress Syndrome Network, reference 6.

  • TABLE 2

    Simplified conservative fluid management protocol (Fluid and Catheter Treatment Trial Lite)

    Central venous pressure, mm Hg (recommended)Pulmonary artery occlusion pressure, mm Hg (optional)Mean arterial pressure ≥ and off vasopressors ≥ 12 hour
    Urine output < 0.5 mL/kg/hrUrine output ≥ 0.5 mL/kg/hr
    > 8> 12Furosemidea; reassess in 1 hourFurosemidea; reassess in 4 hours
    4–88–12Give fluid bolus; reassess in 1 hourFurosemidea; reassess in 4 hours
    < 4< 8Give fluid bolus; reassess in 1 hourNo intervention; reassess in 4 hours

    • ↵a Recommended furosemide dosing: begin with 20-mg bolus or 3-mg/hour infusion or last known effective dose. Double each subsequent dose until goal achieved (oliguria reversal or intravascular pressure target) or a maximum infusion rate of 24 mg/hour or a 160-mg bolus is reached. Do not exceed 620 mg/day. Also, if patient has heart failure, consider treatment with dobutamine.

    • From reference 8.

Back to top

In this issue

Print
Download PDF
Article Alerts
Email Article
Citation Tools

Jump to section