CRITICAL CARE

HANDBOOK
FOR NON-ANAESTHETISTS

Dr Saba Tabish - CT3 Anaesthetics

 TABLE OF CONTENTS

INTRODUCTION .................................................................................................... 2

AIRWAY ...................................................................................................................3

BREATHING ........................................................................................................... 4

DISABILITY ............................................................................................................ 8

MICROBIOLOGY................................................................................................... 10

FEED AND DRUGS ................................................................................................. 11

PERSONAL PROTECTIVE EQUIPMENT ............................................................... 13

PATHOPHYSIOLOGY AND MANAGEMENT OF A COVID-19 PATIENT ............... 17

DAILY ICU MANAGEMENT ALGORITHM ............................................................ 21

1
 INTRODUCTION

Welcome to ITU.

We know that coming to help in ITU was possibly not your choice, but we are very
pleased to have you and whatever level of skill you currently possess you will be useful.

If you are not used to the noise from constant bleeping, machinery and lack of natural
light, ITU can seem a very scary place, so imagine how awful it is for the patients.

We have put together a few handy tips that might help you navigate your first few
days/weeks on the unit. There are a few explanations of different procedures and drug
protocols used for sedation. The hospital KITE site (which you will soon be able to
access from home) has links to many different resources you may find helpful.

Remember, you can still ask questions. Ask as many as you need and do not do any
procedures beyond your competence level.

Wear your PPE.

Please take care of yourself, and do NOT come to work if you are ill.

Dr Rebecca Micklewright
Consultant Anaesthetist
Royal Wolverhampton NHS Trust

2
 AIRWAY

- Patients in ITU may either be breathing spontaneously (with or without added

oxygen) or have their breathing supported in a non-invasive (CPAP/BiPAP) or
invasive (mechanical ventilation) manner.
- In the current health climate, most of the patients in ITU are Covid-19 patients, and
thus their main organ system that needs supporting is respiratory.
- Decision for intubation may be made earlier in Covid-19 patients, to avoid Aerosol
Generating Procedures (AGPs).
- The most senior airway trained individual should manage the airway as per guidance
issued by FICM (Faculty of Intensive Care Medicine)
- Ensure appropriate PPE (FFP3 mask/powered hood, eye protection, full sleeved
disposable gown, non-sterile gloves).
- Use of intubation checklist to ensure full preparedness.
- Try to minimise number of individuals present to reduce risk during the procedure.
- Thorough documentation of procedure: date and time of procedure, names and
grades of people present, equipment used, grade of intubation, length of tube, initial
ventilator settings
- There is a Covid-19 intubation team lead by an anaesthetic consultant, for
intubations done outside of ITU. (contactable on bleep 7161)

Troubleshooting:

- Cuff leak: Monitor airway cuff pressure. if consistently dropping, alert senior. ETT
may need to be changed with full PPE.
- High airway pressures (>30 cmH2O) – consider tube displacement, mucous plugging
(in-line suctioning only with senior advice, as it can worsen pulmonary oedema and
cause derecruitment of alveoli), blocked/saturated HME filter, inadequate
sedation/paralysis. (Think DOPE – displacement, obstruction, pneumothorax,
equipment problems)
- Accidental disconnection – hold your breath, pause the ventilator, clamp the
tracheal tube. Reconnect promptly and unclamp the tracheal tube.

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 BREATHING

Respiratory parameters:

1. Sats> 92%
2. PaO2 > 8 kPa
3. Tidal Volumes 6 ml/kg PBW (use elbow tape if height unknown)

Ventilation Jargon:

1. FiO2: Start high, and then wean down as per respiratory parameters mentioned
above. In severely hypoxaemic patient, start 100% FiO2.
2. Synchronised Intermittent Mandatory Ventilation (SIMV): A mode of ventilation
that supports patients spontaneous breathing with added positive pressure to
generate a desired tidal volume, while also giving controlled mandatory breaths at a
pre-set volume. (Please see figure on next page)
3. Pressure Support Ventilation: The ventilator assists patient’s spontaneous breathing
by adding in positive pressure when inspiratory effort is detected. It can only be used
when the patient is not paralysed and breathing spontaneously, it is frequently used
during weaning.
4. Positive End Expiratory Pressure (PEEP): It’s the pressure in the alveoli at the end of
expiration, its used to splint alveoli open. Generally kept at 5-8 cmH2O, increased
to 15 cmH2O or more in ARDS cases.
5. Inspiratory time, I:E ratios: Normal I:E ratios in spontaneously breathing patients is
1:2-3, which is 1 second for inspiration and 2-3 seconds for expiration. In controlled
ventilation, I:E ratio may be reduced to 1:1.5 (or inspiratory time increased) which
would then allow for a longer time for gas to flow into slow filling lung units, and
for gas exchange.
6. High Flow Nasal Oxygen (HFNO): This is a method of delivering warm and
humidified oxygen at rates upto 60L, the delivered concentration can vary from 21-
100%. It may also provide some CPAP, which reduces work of breathing and
improves oxygenation. (not being used for Covid-19 patients in NX at present)
7. Non-Invasive Ventilation: This ventilation is administered by a tight-fitting face
mask. Its aim is to splint open the alveoli to improve gas exchange. It can either be
CPAP (Continuous Positive Airway Pressure) or BiPAP (Bi-phasic Positive Airway
Pressure). CPAP improves oxygenation, whereas BiPAP also helps with CO2
clearance. Patients do not need to be sedated and can breathe independently. This
is an AGP, thus its use in patients with Covid-19 should only be in isolated areas with
staff in full PPE.

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8. Neuromuscular blockers: If mechanical ventilation is difficult due to poor ventilator
synchrony, reduced chest/lung compliance, paralysing agents are used. NMBs must
always be used in conjunction with sedation, otherwise it leads to awareness and
significant psychological trauma.
9. Prone Positioning: This is a manoeuvre used for patients with ARDS, where they’re
requiring high FiO2. In theory, lying supine causes pulmonary fluid to collect in the
posterior part of the lung thus reducing ventilation, but the same part of the lung is
best perfused due to gravity. Prone positioning causes reduced pleural pressures in
those previously dependant parts thus helping alveoli expand and improve gas
exchange. Proning is done for 16h at a time, and then patients are made supine for
at least 4h prior to proning again.

Puritan Bennet 840 Ventilator in SIMV setting

(https://link.springer.com/article/10.1186/1749-8090-5-39#Sec6)

Troubleshooting:

- Get senior help early!

- Hypoxaemia: Consider increasing FiO2 and/or PEEP (not more than 10, as ­ PEEP
can decrease BP), get senior help.
- High CO2: ­ minute ventilation (Tidal Volume x RR) by ­ respiratory rate
- Unable to adequately ventilate patient: manual bagging NOT recommended in
Covid-19 patients, consider paralysis.

5
 CIRCULATION
CVS parameters:

1. HR<100
2. MAP>65 mmHg
3. Fluid Balance: equal or negative

- Most patients in ITU will have invasive BP monitoring in the form of arterial lines.
- Please see the diagram for arterial waveform interpretation.

An overdamped or underdamped trace indicate a problem in

the arterial line circuit, and thus causes a misinterpretation of
systolic and diastolic BP. MAP, however, is accurate.

Systolic Peak
Pressure

Closure of
aortic valve

MAP SVR

Myocardial contractility

Pulse AUC – Stroke

duration Volume

(https://www.aic.cuhk.edu.hk/web8/haemodynamic%20monitoring%20intro.htm)

- Positioning of the arterial transducer should be at the level of left atrium, otherwise
the readings are skewed.
- Once arterial line is inserted, it needs to be zeroed - to set the baseline of the
waveform as atmospheric pressure.
- Arterial waveform swing: a variation in the amplitude of one waveform to the next
– an indicator of hypovolaemia.

6
Inotropes:

1. Ephedrine: Direct and indirect sympathomimetic agent, acts on both a and b

receptors, HR ­. Given peripherally. Diluted to 3mg/ml, given as 1-3 ml boluses and
titrated to effect.
2. Metaraminol: Direct and indirect sympathomimetic, mainly acts on a receptors thus
cause vasoconstriction and reflex bradycardia. Given peripherally. Diluted to 0.5
mg/ml, given as a 1 ml bolus and titrated to effect.
3. Noradrenaline: Mainly acts on a receptors, thus causing vasoconstriction and reflex
bradycardia. Used in vasodilatory shock. Route of administration is central.
Infusions can range from single strength (80 mcg/ml) to quad strength (320 mcg/ml)
and titrated between 0-20 ml/h.
4. Adrenaline: Acts on a and b receptors, used at a strength which affects b receptors
more, thus causing ­inotropy/chronotropy. Used in cardiogenic shock. Preferred
route of administration is central. Infusions can range from single strength (80
mcg/ml) to quad strength (320 mcg/ml), titrated between 0-20 ml/h.
5. Vasopressin: Used for its effect on V1 receptors on vascular smooth muscles that
cause vasoconstriction. Preferred route of administration is central. Used in
catecholamine resistant septic shock. Avoid vasopressin in patients with gut
ischaemia. It’s made to a concentration of 0.5 U/ml and titrated to effect.
6. Other inotropic agents used in ITU include dobutamine, dopamine, milrinone,
levosimendan.
7. Consider using LiDCO (Haemodynamic monitoring) if on two different vasopressors
or increasing vasopressor requirements.

Fluid Balance: If fluid balance is persistently positive, furosemide is given as a

bolus/infusion to promote diuresis. (Pulmonary oedema may be worsened by a positive
fluid balance; and ventilation is adversely affected)

7
 DISABILITY

Sedation: Some degree of sedation (analgesia + sedation) is often required to allow

patient co-operation with organ system support and associated nursing care.

a. Propofol: Main advantages are that it has a relatively fast action so that its dose can
be more easily titrated to effect and there is little accumulation in the body, so
allowing for the fastest recovery of all sedative agents. Its main disadvantage is that
it causes a profound vasodilatation and some myocardial depression. Therefore, it
should be used in extreme caution in patients who are cardiovascularly unstable.
Concentration: 10 mg/ml
Dose: 0-30 ml/h
b. Alfentanil: Alfentanil is a synthetic opioid which has a rapid onset of action and a
short duration of action. The rapid onset of action makes it easily titratable, and its
short duration of action allows for rapid recovery, even after infusion. Whilst
cardiovascularly stable, it may cause bradycardia, even some degree of hypotension.
Concentration: 0.5 mg/ml
Dose: 0-10 ml/h

RASS Score: This is a score used to target therapy to a certain endpoint. In most
patients, a score of 0 to -2 is desirable, as the aim is to reduce patient’s stress, adrenergic
response and improve tolerance to organ system support. BEWARE OF
OVERSEDATION.

(https://intensiveblog.com/five-tips-for-icu-sedation/)

8
Temperature: Normothermia (36-37 degree Celsius) is aimed for. It’s maintained with
environmental temperature management, blankets, HME filters for ventilated patients
and forced air warmers if required.

Urine Output/Renal Function: On the critical care unit, we aim to optimise renal
function by maximising renal perfusion and by investigating for and treating any easily
reversible causes e.g. bladder outflow obstruction. Oliguria is followed by a rise in urea
and creatinine, eventually causing metabolic acidosis and hyperkalaemia.

Medical measures to treat oliguria include fluid therapy, diuretics like furosemide,
inotropes to improve renal perfusion. If all medical measures fail and renal function
continues to deteriorate it may become necessary to institute renal replacement
therapies such as haemofiltration via a large bore vascular catheter.

9
 MICROBIOLOGY

Lines: A-lines and CVCs are reviewed daily. If the entry site is red, or the line has been
in situ longer than 7-10 days, consider removal and replacement. If the CVC has not
been used >1 day, consider removal.

Cultures: All patients admitted to ITU with sepsis have a blood culture on admission.
Blood cultures may be repeated if a patient continues to spike temperature despite
antimicrobial therapy.

Other cultures include urine cultures, stool cultures, atypical pneumonia screen, viral
throat swabs, tracheal aspirations/BAL fluid for Covid-19. Dates of when cultures were
collected, and the corresponding results should be documented in ITU notes.

(https://jamanetwork.com/journals/jama/fullarticle/2762997)

A patient developing signs of an infection with invasive lines in situ should have the
lines removed, and the tips sent for cultures.

Covid-19 specific blood panel:

1. Troponin - COVID-19 patients with severe disease had higher troponin levels
compared to those with milder disease as per a metanalysis, possibly an
indication of viral myocarditis.
2. D-Dimer – D-Dimer>1 mcg/L has been found to be a poor prognosticator.
3. LDH, Ferritin, Creatine Kinase, Procalcitonin – raised levels have been found
to be an indicator of poor outcome.

Anti-microbials: Anti-microbials are started as per trust guidelines, and with

microbiology input. These medications should be reviewed every 48h.

The guidance around anti-virals and treatment for Covid-19 is quite fluid and changing
day to day, therefore we will not explore that in this handbook.

10
 FEED AND DRUGS

Nutrition: All patients need nutrition to aid the healing process and prevent muscle
breakdown. The stress response to surgery/illness increases the metabolic demand over
the normal state. Such patients are catabolic, breaking down muscle for energy, rather
than anabolic. The under- or mal- nourished patient will not be able to mount a full
immune response.

1. Enteral: This is the route of choice - it has fewer complications and is cheaper. NG
feeding is commenced as per protocol, directed by the nutrition team. NG tubes
are aspirated regularly in intubated patients. If most of what is going in is being
aspirated, the feeds can be slowed down and/or a prokinetic
(metoclopramide/erythromycin) introduced.
2. Parenteral: TPN is infused through a central line, through a dedicated lumen as the
nutrients form a perfect medium for bacterial infections, this lumen has to be
treated with strict asepsis. Bloods of a patient needing TPN need to be monitored
very closely as there is a high risk of electrolyte abnormalities.

Glucose control: Strict monitoring of glycaemic control is required in ITU patients,

due to disturbance of metabolism and increased adrenergic activity. Aim for glucose of
4-10 mmol/L. Start variable rate insulin infusion if blood glucose>10 mmol/L on 2
occasions or the patient has T1DM.

Bowels: Monitor bowel function. If BNO for >2 days, prescribe laxatives and/or
consider suppositories/micro enema. If patient develops diarrhoea, consider sending
stool cultures and review any medications that may be responsible for diarrhoea.

Head of bed elevation: Elevating the head of bed to 30 degrees prevents the risk of
VAP and reduces the likelihood of pulmonary aspiration of contaminated gastric
secretions, especially as NG tubes decrease the competence of the lower oesophageal
sphincter.

Thromboprophylaxis: Critically ill patients are at high risk of developing

thromboembolisms, due to prolonged immobility and vascular injury. Enoxaparin
should be prescribed as per actual bodyweight if INR<2 and platelets>50, Flowtrons
unless contraindicated. VTE assessment to be completed on Vitalpac.

Stress ulcer prophylaxis: Within 24 hours of admission to the ICU, up to 75% of

patients will have gastric erosions although they are often clinically silent. All patients
admitted to ITU are prescribed prophylaxis. Drugs of choice include Ranitidine 50 mg
IV TDS or 150 mg BD PO/NG, Lansoprazole 30 mg OD PO/NG or Omeprazole 20 mg
OD PO/NG.

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12
 PERSONAL PROTECTIVE EQUIPMENT
(Written by Dr Menka Chachlani – CT2 Anaesthetics)

Key things to remember:

- YOUR SAFETY IS A PRIORITY – this means don’t do anything that makes you feel
unsafe, don’t RUSH into anything if you’re not protected, don’t be TOLD you are
wearing ‘too much’ PPE
- PPE is a resource – there is a difference between UTILISING and WASTING
- If you’re going to use it, do it properly, the appropriate length of time and once you
leave, know that you have used the PPE to the best of your ability
- Treat the first layer of PPE as your skin – if this gets dirty, you are in danger of getting
contaminated. Do not wait until your skin gets exposed to ‘redon’

Before you get there:

- Make sure your nails are short, any cuts/scrapes securely plastered
- Hair tied back and ‘base’ surgical cap on (this keeps your hair clean and off your
face)
- Top and bottom scrubs – try not to wear a vest underneath!
- Belongings
§ Consider the choice of work bag – easily wipeable
§ No wallet if not needed – bank card only
§ No lanyard, soap and water to ID every day. Leave out of Covid zone if able
§ Mobile phone – blood forms that have a plastic wallet can be used – drop the
phone in the plastic sheet, seal using the adhesive and peel off the paper form
– this will keep your phone safe on tables etc. Most of us leave phone in office
and you can use it in that plastic case
§ Pens –Never put a pen in your mouth. Never ever take a pen out of the COVID
zone. Regularly wipe the pen clean.
§ Bleeps – bleach wipe between use. Wrap in plastic bag similar to phone. Once
in COVID zone, leave on table on loud so you’re not carrying between
patients
- Drink water, go to the toilet and hands washed up to elbows

13
Donning

- Follow PHE guidance

- It is important to commit to patient care/COVID zone and do everything in
one set of fully donned PPE prior to leaving the zone
- Wash hands à apron à gel hands à gown à gel hands à gloves (base skin)à gel
hands à mask on à leak test à gel hands (yes you can gel gloves) à visor/goggles
+ SECOND surgical cap à 2nd pair of gloves
- Check in with a PPE buddy – don’t go in without both being happy

In the COVID area

- Be mindful about the amount of time you are there – exposure time matters and
is correlated with viral load which is correlated with severity
- Be EFFICIENT
§ Stand as far as possible without compromising care (2m/end of bed)
§ Should be brief review and move on
§ Most skilled/slick person to do clinical skills if possible
- If you are making a jobs list:
§ You cannot take it outside the Covid zone
§ Make a job list on computer inside, email to yourself, and use in clean zone
- Gel gloves between patients, change gloves if soiled/after few patients/eventually
the gel erodes the gloves
- Prior to leaving the bed space, ask nurse/doctor if anything needs to be done – get
it done vs redonning and in/out all the time.

Leaving COVID area

- Inform team/NIC you are leaving – make sure nothing minor needs to be done that
means you will have to redon, re-enter and ultimately waste PPE
- Leave everything (pen/paper) behind, take only bleep back
- Take out bleep from bag à bleach wipe and put on side
- Gel gloves à get rid of gown and first layer of gloves à gel surgical gloves à take
off visor and cap (eyes closed) à gel hands à take off mask by dropping it
FORWARD without touching outside (see below for specifics) à take off surgical
gloves à wash hands up to elbow, wash neck and face if possible
- Leave area à wash hands again

14
SPECIFICS

FFP3 DISPOSABLE MASKS

- Work at maximal efficiency for 45 minutes, up to 4 hours

- Poor seal often in slim faced/ strong jaws
- To take off: lift rubber bands off back of your head, forward and up – DROP into bin

REUSABLE RESPIRATORS

- Bleach wipe before and after use .

- Be economical – use one bleach wipe and START ON INSIDE à then move to
outside, then bin the wipe.
- Don’t wipe out to in/mix it à risk of contamination inside
- Once daily hot soap wash à without filters
- For 3M
§ Best filters are 6035 and 6038.
§ They last 40 hours of continuous use – so about 10 shifts if 4 hours use/shift.
§ Can last up to 3 months if cared for i.e. no water, well bleached, no leak.
- Pros:
§ Can test leak even inside COVID zone – new pair of gloves, grab the filters
and breathe in.
§ Then get Clinell wipes and wipe sides then change gloves.
§ Economical
§ Seal DEFINITELY better
- Cons:
§ Very painful
§ Poor care = massive risk of contamination/exposure

HOODS

- Usually worn by intubators or those who have failed FIT testing.

- Please be mindful they are a SCARCE RESOURCE – if you are just reviewing, no
need. Please donate to intubators who are risking massive amounts of exposure.
- Similar principle of bleaching.
- Always test airflow, filter and battery. (if you do not know how to do this, then you
should not be using the hood)
- Communication is very difficult in hood – have a plan if working as a team as you
will not be able to hear each other.
- Key point à airflow system cannot be occluded by gown otherwise will DRAG AIR
INTO HOOD. So, either:
o Attach full system outside gown and full bleach after

15
 o Wear hood on waist then when tying gown, ensure gap at back exposes back
of system
- Try and wear a simple surgical mask inside – if hood suddenly fails, minor amount
of protection and protects you from inhaling in a potentially contaminated hood.
- NEVER OPEN THE FILTER. Unsure how long filter lasts so always test prior to use.

Leaving work/end of shift

- Well done!
- Wash hands and straight to changing room, try not to linger – shift changes = ‘clean
doctors’ meeting ‘exposed doctors’ so seems pointless to linger
- If showering
§ Scrubs in HOSPITAL laundry (if they are not providing then double bag and
bring home to go straight into washing machine)
§ Showering to include gargling
§ Soap and water to lanyard / car keys
§ Into clean clothes and LEAVE
- Home à clothes off and into washing machine à shower again if you want à wipe
down any surfaces/handles/lights you have touched

There is no doubt we are at risk, and this is by no means fool proof. The key is to
minimise exposure, maximise protection.

YOUR SAFETY IS A PRIORITY

16
 PATHOPHYSIOLOGY AND MANAGEMENT OF A
COVID-19 PATIENT
(Written by Dr Menka Chachlani & Dr Saba Tabish)

COVID-19 does not have a fully understood disease process at this time. While initially
patients requiring critical care were reported to have an ARDS like picture, a recent
paper, penned by critical care doctors in Italy, Germany and the UK, has suggested
that may not be the case for all patients.

HYPOTHESIS:

Different Covid-19 patterns found at pressentation to hospital depend on the

interaction of the following:

TYPE L
1. Low elastance: nearly normal compliance, thus
nearly normal gas volume.
2. Low ventilation to perfusion (V/Q) ratio: since the
gas volume is nearly normal, hypoxemia may be
best explained by the loss of regulation of perfusion
and by loss of hypoxic vasoconstriction.
Accordingly, at this stage, the pulmonary artery
pressure, should be near normal.
3. Low lung weight: Only ground-glass densities are
present on CT scan, primarily located subpleurally
and along the lung fissures – thus only a mild
increase in LW.
4. Low lung recruitability: the amount of non-aerated
tissue is very low, consequently the recruitability is
low.
TYPE H
1. High elastance: increased oedema
causes high elastance and reduced
compliance and lung volume
2. High right-to-left shunt: This is due to
the fraction of cardiac output perfusing
the non-aerated tissue which develops
in the dependent lung regions due to
the increased oedema and
superimposed pressure.
3. High lung weight: Due to pulmonary
oedema
4. High lung recruitability: The increased
amount of non-aerated tissue is
associated, as in severe ARDS, with
increased recruitability.

17
- Patients may present without dyspnoea as the - Patients mainly present with
high compliance allows for increased tidal dyspnoea
volumes

- Type H criteria was found in 20-30% of the patients in the study’s cohort and
fulfilled the criteria for severe ARDS.
- Type L patients may remain static for a while, and then improve or worsen.
- Type L may convert into type H.

RESPIRATORY TREATMENT:

- Type L:
§ Treat hypoxaemia with increasing FiO2 in patients without dyspnoea.
§ In patients with dyspnoea, non-invasive methods to improve ventilation –
HFNO, CPAP (NIV may be associated with high failure rates and delayed
intubation)
§ Measurement of inspiratory pleural pressures is recommended, as
significant pleural pressure swings are associated with conversion to type H.
§ High PEEP not recommended for all patients
§ If intubated and ventilated, patients may be able to tolerate higher tidal
volumes upto 8-9 ml/kg (Consult your seniors)
- Type H:
§ Treat as severe ARDS.

ARDS
DEFINITION OF ARDS:

Acute respiratory distress syndrome is a continuum of life-threatening events

associated with mass inflammatory response and its consequences.

ACUTE HYPOXAEMIA
POOR LUNG COMPLIANCE
NON-CARDIOGENIC PULMONARY OEDEMA

BERLIN CRITERIA FOR DIAGNOSIS OF ARDS:

- Acute (i.e. less than 7 days)

- PaO2/FiO2 <40kPa (mild), <26.6 kPa (moderate), <13.3kPa (severe)
- The need for >5cm H2O PEEP
- Bilateral patchy infiltrates seen on radiography of the chest

18
 - Oedema not explained by cardiac causes

CAUSES:

Direct Indirect
Pneumonia Sepsis
Aspiration Pancreatitis
Lung contusion
Drowning

PATHOPHYSIOLOGY:

Image from Radiopedia.org – the bilateral patchy

opacities are suggestive of ARDS

19
 MANAGEMENT OF ARDS

Summary of the FICM/ICS Guidelines for the management of ARDS in adult patients

(https://www.ficm.ac.uk/sites/default/files/ficm_ics_ards_guideline_-_july_2018.pdf)

20
DAILY ICU MANAGEMENT ALGORITHM

21
 BIBLIOGRAPHY
1. Airway management guidance – ICM Anaesthesia COVID-19
2. Cross-skill training for pandemic Covid-19 – ICM Anaesthesia COVID-19
3. Clinical course and risk factors for mortality of adult inpatients with COVID-19
in Wuhan, China: a retrospective cohort study - Fei Zhou*, Ting Yu*, Ronghui
Du*, Guohui Fan*, Ying Liu*, Zhibo Liu*, Jie Xiang*, Yeming Wang, Bin Song,
Xiaoying Gu, Lulu Guan, Yuan Wei, Hui Li, Xudong Wu, Jiuyang Xu, Shengjin
Tu, Yi Zhang, Hua Chen, Bin Cao
4. Early ARDS management in COVID-19 - Kris Bauchmüller, Helen Ellis, Ajay
Raithatha and Gary Mills - MARCH 2020
5. eLFH Critical Care COVID-19 – Crash Course for Healthcare Staff
6. Respiratory Care and Assessment e-module - Gloucestershire Hospitals NHS
Foundation Trust
7. COVID-19 pneumonia: different respiratory treatment for different phenotypes?
- L. Gattinoni, D. Chiumello, P. Caironi, M. Busana, F. Romitti, L. Brazzi, L.
Camporota
8. Guidelines on the management of Acute Respiratory Distress Syndrome (July
2018) – Faculty of Intensive Care Medicine and Intensive Care Society

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