Front Line COVID-19 Critical Care Consortium urges immediate...

"Oh, what a tangled web we weave, when first we practice to deceive!"

Glad to see Item 4 under the suggested Protocol at the bottom of the page. It includes HCQ as part of the treatment.

Waiting see how the MSN addresses this article.

OK, so we have to understand what this is and I urge to know that I am not criticizing the physicians per se. But this is 7 guys who got together and put our a press release. This is not data driven, it has a flashy name and looks interesting, but this is no different than any other protocol that intensivist nationwide are tweaking in our own institutions. I have a couple of immediate criticisms for this: 1. Low molecular weight heparin is an awful choice. This may accumulate in cases where there is renal impairment and cause far greater harm than good. That being said, with my critically ill patient, I fully heparinize them (infusion) that I can reverse if there is an emergency, and does not have renal metabolic issues. 2. Not reaching toward immediate intubation is the standardprior to a single panicked paper suggesting that HFNC and NIPPV may aerosolize the virus. We literally took several intermediate steps off the table and caused problems (although the 80% mortality once vented number is pure bullish*t) 3. Proning has been used for decades, I have actually had better success with APRV ventilation, but that is a matter of personal preference. What I am getting at is this is a well marketed and probably reasonably good protocol, however most of us are already well into what seems to work and doing it. A neat header and impressive sounding name does not a scientific triumph make...its just really good marketing by these guys,

OK, so we have to understand what this is and I urge to know that I am not criticizing the physicians per se. But this is 7 guys who got together and put our a press release. This is not data driven, it has a flashy name and looks interesting, but this is no different than any other protocol that intensivist nationwide are tweaking in our own institutions. I have a couple of immediate criticisms for this:

1. Low molecular weight heparin is an awful choice. This may accumulate in cases where there is renal impairment and cause far greater harm than good. That being said, with my critically ill patient, I fully heparinize them (infusion) that I can reverse if there is an emergency, and does not have renal metabolic issues.

2. Not reaching toward immediate intubation is the standardprior to a single panicked paper suggesting that HFNC and NIPPV may aerosolize the virus. We literally took several intermediate steps off the table and caused problems (although the 80% mortality once vented number is pure bullish*t)

3. Proning has been used for decades, I have actually had better success with APRV ventilation, but that is a matter of personal preference.

What I am getting at is this is a well marketed and probably reasonably good protocol, however most of us are already well into what seems to work and doing it. A neat header and impressive sounding name does not a scientific triumph make...its just really good marketing by these guys,

Dear Gas_Dr,

Thank you for your many contributions throughout this pandemic. Can you post (or re-post) your current preferred treatment protocol? All the best!

Sincerely,
Dodger

Non Critically Ill (meaning non-ARDS)

1. HCQ + Azithromycin + Zinc (Loading dose HCQ day #1 800 mg, then 400 mg the next 4 days, Azithromycin 500 mg a day for five days. Zinc 220 mg a day for 5 days)

Critically ILL:

The above + convalescent plasma ASAP, heparin infusion protocol for major clotting as in PE, 80 mg solumedrol each day 5 days, Vancomycin for superinfection with Cefepime. APRV ventilation OR prone ventilation. Start with HFNC at first -> >NIPPV -> Intubation monitoring A-a gradient to maintain > 200:1
Aggressive MOSF support, Remdesivir will in theory be in the market Friday. We will see.

Meticulous critical care is the key to management of ARDS.

THIS IS NOT a recommendation or treatment plan, and (lawyer disclaimer) and information herein should be accomplished under the supervision of a properly trained physician and any questions should be directed to the patient primary care or attending physician.

Thank you, Gas_Dr.
Very helpful but can you please spell out acronyms ... APRV, HFNC, NIPPV, MOSF?
Again many tanks!