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Italy informs detailed new guidance on critical care

Tuesday March 24th, 2020

Italian specialists have helped draw up new guidance on the care of critically ill patients with Covid-19 infection.

The guidance was released yesterday by the European Society of Intensive Care Medicine.

The guidance applies the evidence on care of acute respiratory infection to patients afflicted by the pandemic.

It supports the use of oxygen through a protective lung strategy for patients with lungs failing through pneumonia, the society said.

The society also warns of the risk to clinicians, pointing out that in Italy health workers represent 9% of confirmed cases of infection.

The society's president-elect Professor Maurizio Cecconi, from Humanitas University, Milan, Italy, said: "Italy, the most affected Western Country, reports that 12% of all coronavirus positive patients are critically ill and require ICU treatment. ICUs are under huge pressure and intensive care specialists all over the World are working to increase ICU capacity and provide high quality care.

"This is the first guidance to lay out what works and what doesn’t in treating coronavirus-infected patients in intensive care. It’s based on decades of research on acute respiratory infection being applied to COVID-19 patients.

" We make 50 recommendations, with the most important ones relating to the need to ventilate the patients. These are people who have lungs which are failing through pneumonia caused by the coronavirus, and we need to help them through. Giving them oxygen in a “protective lung strategy” can buy them time."

He added: "This is a disease which didn’t exist just a few months ago, so we need to review all possible evidence to ensure that clinicians can use what actually works. We need to make sure that doctors are aware of which treatments are useful and appropriate."

"At the same time as caring for patients, we need to make sure that health workers are following procedures which will allow themselves to be protected against infection. We must protect them, they are in the front line. We cannot allow our healthcare workers to be at risk. On top of that, if they get infected they could also spread the disease further. This is also addressed in the guideline."

A fellow Milanese specialist Professor Giuseppe Citerio said: “COVID-19 cases are rising rapidly worldwide, and so we are increasingly seeing that intensive care units have difficulty in dealing with the tide of patients. We need more resource in ICUs, and quickly. This means more ventilators and more trained personnel. In the meantime, this guidance aims to rationalise our approach and to avoid unproven strategies.”

* Italy's daily death rate from the virus appears to have finally reached a plateau, according to the latest national figures, showing 601 deaths in a single day.

Deaths in Spain continued to accelerate however as yesterday's total neared Italy's at 539 deaths, a 50% increase. France reported 186 deaths including three doctors over two days.

The UK also showed signs of reaching a plateau with 54 deaths and 967 cases reported in a day.

Figures collected from US states continued to paint a confusing picture of the state of the outbreak in the country. This showed 132 new deaths and nearly 10,000 new cases. Overall both the USA and Canada show a case-fatality rate of 1.25%, much lower than the rest of the world.

https://www.esicm.org/wp-content/uploads/2020/03/SSC-COVID19-GUIDELINES.pdf

Tags: A&E | Europe | Flu & Viruses | North America | UK News

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