how are you defining severe vs. moderate?

Just my observation.

Severe: intubated. ARDS. severe hypoxia.
Moderate: viral pneumonia. moderate distress and hypoxia.

This thing is all new. Hell. I'm probably Rxing the triple combo for the moderate ones as well.

The bad thing is - data from China / Italy recommends no HFNC O2 or BIPAP due to increased respiratory droplet transmission. Early intubation a recommendation. So most progressive hypoxic patients will require vents. This is why it may exhaust or supply of vents.

Redesemir showing promise as well. Not available in US yet.

Marcus Aurelius said:

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Redesemir showing promise as well. Not available in US yet.

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Which is just wrong.

Pelayo said:

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Marcus Aurelius said:

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Redesemir showing promise as well. Not available in US yet.

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Which is just wrong.

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On a compassionate basis it is. Which doesn't help test the efficacy

Marcus Aurelius said:

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Just my observation.

Severe: intubated. ARDS. severe hypoxia.
Moderate: viral pneumonia. moderate distress and hypoxia.

This thing is all new. Hell. I'm probably Rxing the triple combo for the moderate ones as well.

The bad thing is - data from China / Italy recommends no HFNC O2 or BIPAP due to increased respiratory droplet transmission. Early intubation a recommendation. So most progressive hypoxic patients will require vents. This is why it may exhaust or supply of vents.

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Im still not sure I agree with those recs, as it would quickly exhaust our vents. Preferably I'd be putting patients that can tolerate it on bipap, making sure mask fit is optimal and making sure we have viral particle filter on.

Pelayo said:

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Marcus Aurelius said:

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Redesemir showing promise as well. Not available in US yet.

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Which is just wrong.

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Why can't they make it available just for this case? This is wrong ... politicians getting in between medicine for their cut ?

Dr. Not Yet Dr. Ag said:

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Marcus Aurelius said:

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Just my observation.

Severe: intubated. ARDS. severe hypoxia.
Moderate: viral pneumonia. moderate distress and hypoxia.

This thing is all new. Hell. I'm probably Rxing the triple combo for the moderate ones as well.

The bad thing is - data from China / Italy recommends no HFNC O2 or BIPAP due to increased respiratory droplet transmission. Early intubation a recommendation. So most progressive hypoxic patients will require vents. This is why it may exhaust or supply of vents.

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Im still not sure I agree with those recs, as it would quickly exhaust our vents. Preferably I'd be putting patients that can tolerate it on bipap, making sure mask fit is optimal and making sure we have viral particle filter on.

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I hate venting when I don't have to, but it's probably best until we get to that point.

The problem is that we don't know if they have CV until we test which is currently taking over 2 days. I guess it'd be easy once it becomes more common than alternative diagnoses, but I just can't get on board intubating every PUI that I think would likely do well on NIV.

Layman question here, but are BiPaps similar to cpaps? If so, aren't there a ton of those on the market?

With the increased droplet transmission data via HNFC and BIPAP I think these pts are getting intubated early.

South Korea is using chloroquine with zinc as an antiviral treatment. Extremely cheap and available.

Covid-19 Drug Therapy

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In the absence of an established treatment regimen, the China International Exchange and Promotive Association for Medical and Health Care (CPAM) issued a novel 2019 coronavirus disease (COVID-19) guideline in February 2020 with recommendations on methodology, epidemiological characteristics, disease screening and prevention, diagnosis, treatment and control, nosocomial infection prevention and control, and disease nursing. For direct antiviral treatment of SARS-CoV-2, CPAM recommends use of lopinavir; ritonavir [2 capsule (dose undefined) by mouth twice daily] in combination with nebulized alfa-interferon (5 million units in Sterile Water for Injection inhaled twice daily). CPAM has based this recommendation on weak evidence from retrospective cohort, historically controlled studies, case reports, and case series that suggest clinical benefit of lopinavir; ritonavir in the treatment of other coronavirus infection [i.e., 2002 SARS-CoV and 2012 Middle East respiratory syndrome coronavirus (MERS-CoV)]. (4) (8) (7)

In addition to CPAM, a group of Korean physicians with experience in treating SARS-CoV-2 infected patients have developed recommendations for the treatment of COVID-19. According to these physicians, antiviral medications are not recommended for use in young, healthy patients with mild symptoms and no underlying comorbid conditions. However, treatment with lopinavir 400 mg; ritonavir 100 mg (2 tablets by mouth twice daily) or chloroquine (500 mg by mouth twice daily) should be considered for use in older patients or patients with under underlying conditions and serious symptoms. If chloroquine is unavailable, they recommend considering use of hydroxychloroquine (400 mg by mouth once daily). Use of ribavirin and interferon were not recommended as first-line treatments because of the risk for side effects; however, use of these medications may be considered if treatment with lopinavir; ritonavir, chloroquine, or hydroxychloroquine are ineffective.

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Maybe time for me to disinfect my CPAP. It appears the difference is that one lessens pressure on exhale. Which my CPAP does. Maybe my CPAP is advanced. Maybe I dont really know what I'm talking about.

Marcus Aurelius said:

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Redesemir showing promise as well. Not available in US yet.

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Concerning remdesivir......

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All three patients treated with remdesivir recovered, but they also reported significant gastrointestinal symptoms. Investigators also noticed elevated liver enzyme levels in their blood samples.
Given the lack of available virus-attacking treatments for COVID-19, some gastrointestinal discomfort isn't such a big deal, but elevated liver enzymes could nail remdesivir's coffin shut.

While all three experienced gastrointestinal issues, one was complaining of diarrhea before receiving remdesivir. Nothing tanks an experimental new drug faster than elevated liver enzymes, but concentrations among some patients that weren't treated with remdesivir peaked higher than those that were.

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Small number of patients, all with severe symptoms.

JTA1029 said:

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Maybe time for me to disinfect my CPAP. It appears the difference is that one lessens pressure on exhale. Which my CPAP does. Maybe my CPAP is advanced. Maybe I dont really know what I'm talking about.

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Your CPAP likely has a C-Flex option, which can reduce the pressure a little bit on exhale. The bipap can reduce significantly more.