April 7, 2020

As healthcare providers have treated patients with COVID-19 around the world, evidence has demonstrated key principles to optimize clinical care of COVID-19 patients and the safety of the providers and associates who care for them.

The following principles should guide care of COVID-19 patients at MedStar Health.

Principles for respiratory care of the COVID-19 patient or PUI:

  1. Improving Oxygenation/Ventilation
    • When possible, prioritize:
      • Nasal Cannula (less than 6 lpm)
      • Non-Rebreather
    • Avoid:
      • Oxy-mask and high flow nasal cannula: Due to aerosolization
      • Non-invasive ventilation/BIPAP
        • COVID-19 patients have a high BIPAP failure rate
        • Increased risk of viral spread due to aerosolization
    • Consider early intubation for patients in hypoxemic or hypercapnic respiratory failure
  2. Bronchodilator Therapy
    • During invasive mechanical ventilation: use inhaled medications via nebulizer
    • Spontaneously breathing patients:
      • Strong preference for metered-dose inhaler (MDI) therapy over nebulizer to minimize risk of viral aerosolization, to reduce staffing time to administer the medication, and to conserve N95 respirators
      • In consideration of potential supply constraints, see the attached modified “Common Canister” MDI administration protocol to conserve MDI supply
  3. Viral/HEPA Filters
    • When available, Viral/HEPA filters should be utilized when a patient is mechanically ventilated or when a bag-valve-mask is required
  4. Intermittent Pulse Oximeter Cleaning
    • Pulse oximeters for intermittent use must be thoroughly disinfected after every use with wipes approved for use against COVID (list available on StarPort)
  5. Personal Protective Equipment (PPE)
    • Patients Under Investigation PUIs in the ICU for every interaction
      • Face shield
      • N95 respirator
      • Gown & gloves
    • PUIs outside the ICU for every interaction
      • Face shield
      • Surgical mask
      • Gown & gloves
    • If PUI requires an aerosol-generating procedure (e.g. intubation, tracheal or laryngeal suctioning, nebulizer treatment), WHILE PROCEDURE IS ONGOING AND FOR THE FOLLOWING 2 HOURS:
      • Face shield
      • N95 respirator
      • Gown & gloves

SEE the job aid and guidelines in the document below for full details on these principles.