Management of Critically Ill Patients
MayBelow are guidelines, courses, training materials, research, and additional resources that cover a wide range of topics related to the management of critically ill COVID-19 patients.
Guidelines
COVID-19 Treatment Guidelines Dashboard
This resource aggregates guidelines for COVID-19 care from leading global healthcare authorities.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Open Critical Care. Continuously updated
Care of COVID-19 Patients in Surguja – Guidance Document
A comprehensive guideline created by a group of Indian rural health physicians for healthcare workers on how to treat patients with severe symptoms of COVID-19 in rural settings.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Sangwari People’s Association for Equity and Health. Updated 5/20/2021
HDU Drugs Ready Reckoner for COVID 19
A comprehensive guideline created by a group of Indian rural health physicians for healthcare workers on the various drugs that can be utilized for different symptoms of COVID-19.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Sangwari People’s Association for Equity and Health. Updated 5/20/2021
NIH Oxygenation and Ventilation Guidelines
- Language: English
- For: Nurses, Physicians, Respiratory Therapists
- Created by: NIH. Updated: 12/17/2020
WHO Clinical Management of Severe Acute Respiratory when COVID-19 Suspected
Includes management of pregnant women and pediatric patients
- Language: English
- For: Nurses, Physicians, Respiratory Therapists
- Created by: WHO. Updated 3/13/2020
HEALTH SYSTEMS MANAGEMENT
Configuring your ICU and How to Craft Novel ICU Space for COVID-19 care
- Languages: English, Hindi
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Dr. Halpern, MD, Memorial Sloan Kettering Cancer Center, NYC
SPECIAL SCENARIOS
COVID-19: Sepsis Without an Antibiotic –
Manual discusses sepsis in COVID-19 and antibiotic stewardship principles pertaining to it
- Languages: English, Hindi
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Angel Coz, MD, University of Kentucky and CHEST
A Practical Guide to the Diagnosis and Management of Acute Stroke Syndromes in COVID-19 Patients
- Languages: English, Hindi
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Hooman Kamel, Weill Cornell Medicine
Courses and Training Materials
Ventilators for Nonintensivists. Basic Ventilator Parameters
8-minute video
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: American Thoracic Society. Update 4/09/2020
Ventilators for Nonintensivists. Basic Modes and Breath Types
10-minute video
- Created by: American Thoracic Society. Updated: 4/15/2020
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: American Thoracic Society. Updated 4/21/2020
Just-In-Time Tools for Training Non–Critical Care Providers. Basics of Respiratory Failure
This article presents five guides related to the evaluation and management of patients with hypoxemic respiratory failure and the basics of invasive mechanical ventilation.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Joshua Lee, et al., American Thoracic Society. Updated: 4/14/2020
Basic Assessment and Support in Intensive Care for COVID-19
12-hour course comprising e-lectures, live teleconference skills, and activities in the BASIC App to train doctors to care for critically ill ventilated patients
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Open Critical Care
Fundamental Critical Care Support (FCCS) Course
Course for health professionals, including non-intensivists, on managing critically ill COVID patients for the first 24 hours
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Society of Critical Care Medicine
WHO Clinical Care Severe Acute Respiratory Infection Training
10-hour course
- Languages: English, Français, русский, Português, Bahasa Indonesia, Tiếng Việt, Español, македонски, العربية -, Tetun, සිංහල
- For: Nurses, Physicians, Respiratory Therapists
- Created by: WHO
COVID-19 Respiratory Care Teaching Material
Slides decks intended to serve as a framework for use by local instructors supporting healthcare workers caring for COVID19 patients
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Open Critical Care
PRONING
COVID-19: The Science Behind Prone Positioning
- Languages: English and Hindi
- Aimed at: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Society of Critical Care Medicine
NON-INVASIVE & INVASIVE VENTILATION
Invasive or Noninvasive Support: When, Where, and How
Slide deck on the role of pulmonary physiology in making decisions about external support in COVID-19 patients
- Language: English and Hindi
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: Society of Critical Care Medicine
INVASIVE MECHANICAL VENTILATION
Harvard Mechanical Ventilation for COVID-19 Course
One-week course providing licensed medical professionals with an understanding of mechanical ventilation to support the critical care team in caring for COVID-19 patients.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists
- Created by: Harvard University-EDX. Updated: April 2021
Mechanical Ventilation for COVID-19 Patients
Slide decks
- Created by: Boston University. Updated: 9/12/2020
- Languages: English, Hindi
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
AIRWAY
Airways management: tracheal intubation
1-hour course
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Created by: BMJ Learning Editors. Updated: 9/14/2020
WEANING VENTILATOR
Evidence-based practice of weaning from ventilator: A Review
1-hour course
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Saikat Sengupta, et al. Updated: 2/06/2018
COVID-19 Case Series for Teachers
Adaptable slide decks for use by local instructors supporting healthcare workers caring for COVID-19 patients.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Open Critical Care. Updated: 2021
Research
Prophylactic anticoagulants for people hospitalised with COVID-19
Systematic review to assess the effects of prophylactic anticoagulants versus active comparator, placebo or no intervention, on mortality and the need for respiratory support in people hospitalized with COVID-19.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Flumignan RL, Tinôco JDS, Pascoal PI, Areias LL, Cossi MS, Fernandes MI, Costa IK, Souza L, Matar CF, Tendal B, Trevisani VF, Atallah ÁN, Nakano LC. Prophylactic anticoagulants for people hospitalised with COVID-19. Cochrane Database Syst Rev. 2020 Oct 2;10:CD013739. doi: 10.1002/14651858.CD013739. PMID: 33502773.
Prone Positioning in Severe Acute Respiratory Distress Syndrome
Randomized control trial involving 466 patients with severe ARDs undergoing early prolonged prone positioning and its effect in decreasing 28-day and 90-day mortality, with severe ARDS (PaO2/FIO2 < 150 mmHg). The treatment group was placed in the prone position within the first 3-4 days
- Language: English
- For: : Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. doi: 10.1056/NEJMoa1214103. Epub 2013 May 20. PMID: 23688302.
Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19
Benefits of prone positioning through prospective cohort study of adult patients confirmed with COVID-19 related pneumonia receiving supplemental oxygen or non-invasive continuous positive airway pressure.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Coppo A, Bellani G, Winterton D, Di Pierro M, Soria A, Faverio P, Cairo M, Mori S, Messinesi G, Contro E, Bonfanti P, Benini A, Valsecchi MG, Antolini L, Foti G. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. Lancet Respir Med. 2020 Aug;8(8):765-774. doi: 10.1016/S2213-2600(20)30268-X. Epub 2020 Jun 19. PMID: 32569585; PMCID: PMC7304954.
High-Flow Oxygen through Nasal Cannula in Acute Hypoxemic Respiratory Failure
Multicenter, open-label trial evaluating noninvasive ventilation administration via nasal cannula in patients with acute hypoxemic respiratory failure.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, Prat G, Boulain T, Morawiec E, Cottereau A, Devaquet J, Nseir S, Razazi K, Mira JP, Argaud L, Chakarian JC, Ricard JD, Wittebole X, Chevalier S, Herbland A, Fartoukh M, Constantin JM, Tonnelier JM, Pierrot M, Mathonnet A, Béduneau G, Delétage-Métreau C, Richard JC, Brochard L, Robert R; FLORALI Study Group; REVA Network. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015 Jun 4;372(23):2185-96. doi: 10.1056/NEJMoa1503326. Epub 2015 May 17. PMID: 25981908.
Mechanical ventilation: lessons from the ARDSNet trial
Seminal trial: In patients with acute lung injury and the acute respiratory distress syndrome, mechanical ventilation with a low (6 ml/kg predicted weight) vs than “standard” (12 ml/kg predicted weight) tidal volumes reduced mortality from 40% to 30%. Provides much of the evidence and need for low tidal volume lung protective ventilation.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Slutsky AS, Ranieri VM. Mechanical ventilation: lessons from the ARDSNet trial. Respir Res. 2000;1(2):73-7. doi: 10.1186/rr15. Epub 2000 Aug 31. PMID: 11667968; PMCID: PMC59545.
Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study
Multicenter, retrospective observational study at 18 ICUs in Netherlands evaluating prone positioning and lung protective ventilation in with patients with COVID-19 invasively ventilated.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Botta M, Tsonas AM, Pillay J, Boers LS, Algera AG, Bos LDJ, Dongelmans DA, Hollmann MW, Horn J, Vlaar APJ, Schultz MJ, Neto AS, Paulus F; PRoVENT-COVID Collaborative Group. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. Lancet Respir Med. 2021 Feb;9(2):139-148. doi: 10.1016/S2213-2600(20)30459-8. Epub 2020 Oct 23. PMID: 33169671; PMCID: PMC7584441.
Neuromuscular blockers in early acute respiratory distress syndrome
Multicenter RCT of 340 patients with severe ARDS found early use of 48 hours of neuromuscular blockade reduced mortality compared to placebo (NNT of 11 to prevent one death at 90 days in all patients, and a NNT of 7 in a prespecified analysis of patients with a PaO2:FiO2 less than 120). Of note, patients randomized to paralytic did not have an increased incidence of ICU-acquired weakness at 28 days.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- Papazian L, Forel JM, Gacouin A, Penot-Ragon C, Perrin G, Loundou A, Jaber S, Arnal JM, Perez D, Seghboyan JM, Constantin JM, Courant P, Lefrant JY, Guérin C, Prat G, Morange S, Roch A; ACURASYS Study Investigators. Neuromuscular blockers in early acute respiratory distress syndrome. N Engl J Med. 2010 Sep 16;363(12):1107-16. doi: 10.1056/NEJMoa1005372. PMID: 20843245.
Comparison of two fluid-management strategies in acute lung injury
This randomized study is widely cited as the rationale for aggressive diuresis in ARDS patients. Of note, the study protocol is highly complex and relies on CVP and PA catheter measurements, limiting its direct clinical applicability.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems, Public Health Organizations
- National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network, Wiedemann HP, Wheeler AP, Bernard GR, Thompson BT, Hayden D, deBoisblanc B, Connors AF Jr, Hite RD, Harabin AL. Comparison of two fluid-management strategies in acute lung injury. N Engl J Med. 2006 Jun 15;354(24):2564-75. doi: 10.1056/NEJMoa062200. Epub 2006 May 21. PMID: 16714767.
Additional Resources
CHECKLISTS/ALGORITHMS FOR CLINICAL CARE AND ROUNDING
COVID-19 Clinical Practice Protocols – Critical Care Management
Guidelines, recommendations, and therapeutics for the critical management of COVID-19.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Brigham’s and Women’s Hospital
- Language: English
- For: Nurses, Physicians, Hospital and Health Systems
- Created by: Open Critical Care. Updated: 3/10/2020
Respiratory Care Pocket Card
Tips and important points regarding oxygen sources and delivery, respiratory care, setup and monitoring, ventilator modes, and respiratory mechanics.
- Language: English
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Open Critical Care. Updated: April 2021
Respiratory Care Protocol Templates
Respiratory care protocols and algorithms with order set checklists to guide ventilator management, breathing trials, cuff leak tests and difficult to wean patients.
- Languages: English, Spanish
- For: Nurses, Physicians, Respiratory Therapists, Hospital and Health Systems
- Created by: Open Critical Care. Updated: February 2021
RISK CALCULATORS
The JHU COVID Inpatient Risk Calculator: CIRC
CIRC uses factors on admission to the hospital to predict the likelihood that a patient admitted with COVID-19 will progress to severe disease or death within 7 days of arrival.
- Language: English
- For: Nurses, Physicians, Hospital and Health Systems
- Created by: Grant Schomock, et al., Johns Hopkins University
JHU Severe COVID-19 Adaptive Risk Predictor (SCARP)
SCARP is a tool that calculates the 1-day and 7-day risk of progression to severe disease or death for adult patients (18 years and older) who are hospitalized with COVID-19.
- Language: English
- For: Nurses, Physicians, Hospital and Health Systems
- Created by: Johns Hopkins University
*The resources for this section were reviewed by Johns Hopkins University students Shiree Patel, Researchers Noor Zanial and Angela Chang, and Pulmonary Critical Care Fellow Dr. Bhavna Seth on behalf of the Johns Hopkins India Institute COVID-19 Task Force Technical Working Group.