latest knowledge practical points short presentation It will serve as guideline for Covid-19 corona virus it will help in preparing ICU as well as policy making institutions should device their own strategy

1. ICU Preparedness for Covid-19
PandemicPandemic
Fakhir Raza
SIUT
12-March-2020

2. Summary
• Pandemics and epidemics are unique challenges
for ICU preparedness. In a highly mobile,
globalized world, infectious disease is no longer
confined to fixed geographic regions. The risks of
pandemic disease to clinical staff requires that
institutions have mechanisms to protect their
pandemic disease to clinical staff requires that
institutions have mechanisms to protect their
personnel while also providing adequate care to
affected patients. Engagement of community
partners is necessary to permit adequate data
collection, to develop ethical standards for
resource allocation, and to manage anxiety and
expectations among the public

3. “stuff, staff, and space”
• Besides Covid-19 ICUs may be burdened with
other disasters like hurricanes, wars and
earthquakes (non infectious)
• In infectious pandemic HCWs are at risk due to• In infectious pandemic HCWs are at risk due to
their actual work and measures have to be
taken to protect them from infection as well
as prevent absenteeism

4. “Stuff”: Supply Requirements for
Pandemic Preparedness
• ICU should be prepared of caring the patients
for 96 hours without outside supplies
• In cases of disaster this rule should be
complied as well.complied as well.
• We should expect at least double the load as
compared to usual routine work in ICU

5. “Stuff”: Supply Requirements for
Pandemic Preparedness
• Disposable items (masks, gowns, suction
catheters) pharmaceuticals (and particularly
antimicrobial drugs)
• Mechanical ventilators
• When additional supplies are not available,• When additional supplies are not available,
alternative methods to provide respiratory
support may need to be considered, such as
– the use of anesthesia ventilators,
– high-flow nasal cannula oxygenation,
– noninvasive positive pressure ventilation for selected
patients

6. “Stuff”: Supply Requirements for
Pandemic Preparedness
• Oseltamivir and peramivir for influenza, plus
appropriate antimicrobial drugs for secondary
bacterial infections
– intravenous fluids,
– agents for rapid-sequence intubation,– agents for rapid-sequence intubation,
– analgesics and sedatives for intubated patients,
– vasopressors,
– venous thromboembolism prophylaxis,
– neuromuscular blockade agents for patients with
severe hypoxemic respiratory failure

7. “Stuff”: Supply Requirements for
Pandemic Preparedness
• Laboratory equipment and kits
• Waste disposal equipment

8. “Staff”: Increasing the Safety of
Trained Personnel
• Trained personnel.
• In case of shortage: trained critical care
personnel supervise staff experienced in acute
care (eg, hospitalists, medical/surgical nurses,care (eg, hospitalists, medical/surgical nurses,
general inpatient pharmacists)
– (Trained staff intervening directly for highly
complex patients as well as for emergencies and
procedures)

9. “Staff”: Increasing the Safety of
Trained Personnel
• Protect your “Staff”
– Careful infection prevention practices,
– the use of personal protective equipment (PPE),
– Sadly no vaccine available– Sadly no vaccine available
– Flu vaccine for all staff
– N-95 for laboratory workers and ICU workers in
direct contact with secretions
– Closed circuit suction in ventilated patients

10. “Staff”: Increasing the Safety of
Trained Personnel
• Staff may get sick (and they really can)
• They must avoid coming to work and must
seek medical advice
• This will lower the risk of spreading infection• This will lower the risk of spreading infection
in HCWs

11. “Space”: Critical Care Without an
Intensive Care Unit
• Separate rooms are desirable but not always
practical
• Cohorting confirmed cases of Covid-19 may be
necessary to avoid spread of infectionnecessary to avoid spread of infection

12. “Space”: Critical Care Without an
Intensive Care Unit
• Moving less sick patients from ICU to
accommodate more sick patients lying in ED
or medical floor
– patients not requiring mechanical ventilation,– patients not requiring mechanical ventilation,
vasopressor support, or intensive
neuromonitoring
I take it as a golden opportunity with support of the
ministry and police to move unnecessary staying
patients in ICU

13. Temporary ICU building
• Postanesthesia care unit (PACU) or a
monitored step-down unit
– (Cancellation of elective surgical procedures may
open up the PACU and same-day surgical units asopen up the PACU and same-day surgical units as
auxiliary ICUs and step-down units, for example.)

14. Planning for pandemics
1. Triage and resource allocation
– Scarce resources, such as ECMO or access to an
ICU, will require allocation in a manner that is
open, consistent, and based on broadly acceptedopen, consistent, and based on broadly accepted
ethical principles
– reasonable chances of survival
– critically ill patients denied ICU admission in a
disaster must receive appropriate and
compassionate palliative care.

15. Planning for pandemics
2. Optimization of staffing
– The hospitals prepared with Ebola Treatment
unit capability – regular refresher training
– staff training on infection prevention practices– staff training on infection prevention practices
for pandemic threats
– Training donning and doffing of PPE and PAPR
use, should be routine for institutions

16. PAPR
Purified Air Powered Respirator

17. Planning for pandemics
3. Equipment, supplies, and space
– The Joint Commission-mandated 96-hour supply
requirement (including food, water, consumables,
and medications)and medications)
– Coordination with nearby hospitals,
pharmaceutical vendors, and regional and
national health authorities, including via the
Strategic National Stockpile

18. Planning for pandemics
5. Public Health
– Hospitals and ICUs must have plans to coordinate
with public health authorities for
1. identification of cases,
2. access to diagnostics,2. access to diagnostics,
3. and tracking of potentially contagious individuals as
part of outbreak investigations.
4. Systematic data collection, either through
government, academic, or combined networks, is
similarly crucial to test interventions to end an
epidemic

19. Planning for pandemics
5. Public affairs
– Transparency
– Confidentiality
– Ethical consideration for allocation of ventilator– Ethical consideration for allocation of ventilator
– Media interaction (regularly)
– Collaboration with public health authorities
–

20. This article is prepared using following link
• https://sccm.org/Disaster/COVID-19-ICU-
Preparedness-
Checklist?_zs=X7asi1&_zl=7MSb6

21. This article is prepared using following link
• https://www.sciencedirect.com/science/articl
e/pii/S0749070419300405?via%3Dihub#bib10

22. Worth reading
• https://jamanetwork.com/journals/jama/fullarticle/2762996
published on 11-March-2020
• Don’t use NIV and HFNC
https://www.thelancet.com/action/showPdf?pii=S2213-
2600%2820%2930110-7
• Ebola's Message: Public Health and Medicine in the Twenty-First
Century edited by Nicholas G. Evans, Tara C. Smith, Maimuna S.Century edited by Nicholas G. Evans, Tara C. Smith, Maimuna S.
Majumder
• Use of Air Powered respirators
https://reader.elsevier.com/reader/sd/pii/S0166354213002246?tok
en=84374D61DD2B8C14ED93ABE4FCB3FED8DBDB109D3962F722D
21D0F457A345B1CED50B429BFA1DAA8FBAE2713A05BE3D5
• https://netec.org/