Draegerwerk Ag & Co. Kgaa · XETR:DRW8

Draegerwerk Ag & Co. Kgaa — Drägerwerk AG & Co. KGaA — Webinar Series Respiratory Care COVID (October 2020)

34 slides from Draegerwerk Ag & Co. Kgaa's conference presentation, Oct 27, 2020

1. Slide 1: COVID 19: My experience both as patient and clinician

   COVID 19: My experience both as patient and clinician Prof. Javier García Fernández. MD. Ph.D. MBA. Chairman of Anaesthesia, Critical Care and Pain Service. Puerta de Hierro Univ. Hospital. Associate Professor. Medical School. UAM. Madrid

2. Slide 2: Comparison between first and second wave in Madrid

   Comparison between first and second wave in Madrid Number of patients admited to the hospital

3. Slide 3: First wave in Madrid: Red line = ICU beds

   First wave in Madrid: Red line = ICU beds

4. Slide 4: Second wave in Madrid

   Second wave in Madrid Blue line = at the ward // red line = ICU beds

5. Slide 5: Second wave in Madrid: occupation of ICU beds

   Second wave in Madrid Purple line = ocupation ICU beds

6. Slide 6: Interpreting Diagnostic Tests for SARS-CoV-2

   From: Interpreting Diagnostic Tests for SARS-CoV-2 JAMA. Published online May 06, 2020. doi:10.1001/jama.2020.8259 Figure Legend: Estimated Variation Over Time in Diagnostic Tests for Detection of SARS-CoV-2 Infection Relative to Symptom OnsetEstimated time intervals and rates of viral detection are

7. Slide 7: COVID-19 Initial Management

   COVID-19 INITIAL MANAGEMENT 1117 ICU Patients 29 No COVID 1088 ICU Patients 7 alta/éxitus día 0 1081 ICU Patients 97 No datos 984 ICU Patients 214 HFNT HFNT + Prono = 27.5% 772 Mechanical ventilation 27% https://covid19.ubikare.io/

8. Slide 8: Main features and ventilatory management of patients with ARDS caused by COVID-19

   Main features and ventilatory management of patients with acute respiratory distress syndrome caused by COVID-19 Running title: ARDS caused by COVID-19 Cumulative % of patients with Recruitment Maneuvers All Mild ARDS Moderate ARDS Severe ARDS Cumulative % of patients with Prone Position 100 100 80

9. Slide 9: Conclusions

   Conclusions: - COVID-19 ARDS is an ARDS that should be ventilated following ARDS protocols. - COVID-19 ARDS may response better than others to prone position (Oxygenation)

10. Slide 10: Is there any hope to change things in Mechanical Ventilation?

    Is there any hope to change things in Mechanical Ventilation?

11. Slide 11: Respiratory care from the point of view of a doctor who was a patient

    Respiratory care from the point of view of a doctor who was a patient, at the same time

12. Slide 12: Respiratory symptoms: what is important?

    Respiratory symtoms: what is important ?  The most important is Dyspnea in a risk factors patient, at 7-8 day after symptoms started. Cough is quite significant too.  The most trustable alteration: reduction in pulseoximeter and CT  Thorax X-Ray: low sensitivity, 35 % of false negatives Acute Res

13. Slide 13: Clinical consensus recommendations on non-invasive respiratory support

    Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection  Clinical symptoms: • Moderate-Severe Dyspnea with increase in WOB • Tachypnea > 30 bpm  BAG criteria: • PaO2/FiO2 < 200 (FiO2 higher

14. Slide 14: Clinical consensus recommendations on non-invasive respiratory support

    Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection  First step we sugget HFNC follow by second step CPAP (helmet/panfacial) never delay intubation in WOB is increasing or BGA goes worse.

15. Slide 15: Clinical consensus recommendations on non-invasive respiratory support

    Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection  Choice of the type of interface: 1º Helmet, 2º full face mask or nasobucal, NEVER only nasal  We misadvise the use of an anti-rebreat

16. Slide 16: Therapeutic steps in COVID ARF

    Therapeutics steps in COVID 19 ARF 4º ECMO: Indication = PaO2/FiO2 < 80 refractary to MV 3º INTUBATION y MV: Prono Indication = Saturation < 93 % with CPAP 10 cmH2O y FiO2 > 0,7 2º NIV: Indication = Saturation < 93 % with FiO2 > 0,4 1º OXIGENOTHERAPY: Indication = Saturation < 93 % with 21% of FiO2

17. Slide 17: PRONE, PRONE Y PRONE, and then more PRONE

    PRONE, PRONE Y PRONE, and then more PRONE…  The most power tool to fight against Hypoxemia in the COVID 19 pneumonia is prone position for moderate and severe ARDS (Pa2/FiO2 < 150)  There must be “prone-teams” at the ICU (groups of 4-5 people)  Long cycles (16-24 hours), only change ones at day,

18. Slide 18: Atelectasias y COVID 19

    Prevalence and clinical consequences of atelectasis in SARS-CoV-2 pneumonia. Atelectasias y COVID 19 Mingote, A.1 ; Albajar, A. 1; García Benedito, P.2; García-Suárez, J.1; García- Fernández, J. 1,3  237 CT  24 % de atelectasias: 19 % segmentarias y 5 % lobares

19. Slide 19: Atelectasias y COVID 19

    Prevalence and clinical consequences of atelectasis in SARS-CoV-2 pneumonia. Atelectasias y COVID 19 Mingote, A.1 ; Albajar, A. 1; García Benedito, P.2; García-Suárez, J.1; García- Fernández, J. 1,3

20. Slide 20: Atectasias y COVID 19

    Prevalence and clinical consequences of atelectasis in SARS-CoV-2 pneumonia. Atectasias y COVID 19 Mingote, A.1 ; Albajar, A. 1; García Benedito, P.2; García-Suárez, J.1; García- Fernández, J. 1,3

21. Slide 21: Our findings: Atelectasis

    OUR FINDINGS: ATELECTASIS DR. CLARA SALAS. CHAIRMAN OF PHATHOLOGICAL ANATOMY DEPARTMENT. H. U. PUERTA DE HIERRO. MADRID

22. Slide 22: Steroids therapy

    Steroids therapy  So far the only drug improves survive in COVID 19  ”The drug of live in COVID 19..” Dr. Javier García, April 5th, 2020  The big problem about steroids is confuse: “TIMING vs. DOSAGE”, people want to solve a timing problem with a high late doses, and create a second bigger proble

23. Slide 23: Our findings

    Our findings: Dr. Clara Salas. Chairman of Phathological Anatomy Department. H. U. Puerta de Hierro. Madrid

24. Slide 24: The most hidden lethal weapon of this virus: thrombosis

    The most hiden letal weapon of this virus: trombousis  Nobody advised us about this  There are many factors beside the endotheliophaty which explains it.  Patient with systemic affectation stay all the time at bed plus de-hydration, plus obesity plus the activation of pro-thrombotic cascade plus

25. Slide 25: Lung parenchyma with diffuse alveolar damage

    Lung parenchima with diffuse alveolar damage: Panel A: exudative phase with jaline membranes (arrow); Panel B: organising microthrombus (arrow)

26. Slide 26: Capillaritis and alveolar hemorrhage

    “CAPILLARITIS” AND ALVEOLAR HEMORRHAGE. DR. CLARA SALAS. CHAIRMAN OF PHATHOLOGICAL ANATOMY DEPARTMENT. H. U. PUERTA DE HIERRO. MADRID

27. Slide 27: Diffuse alveolar damage (DAD) and holes = VILI

    DIFFUSE ALVEOLAR DAMAGE (DAD) AND “HOLES”= VILI DR. CLARA SALAS. CHAIRMAN OF PHATHOLOGICAL ANATOMY DEPARTMENT. H. U. PUERTA DE HIERRO. MADRID

28. Slide 28: Clinical case

    Clinical case  62 years old, 25 days of VM  Sudden desaturation and hypotension  Tension pneumothorax

29. Slide 29: Double-lung transplant in a woman in her 20s

    Doble-Lung transplant in a woman in her 20s. Nothwestern Medicine Chicago

30. Slide 30: Take home messages

    Take home messages • NIV: 1º HFNC // 2º CPAP 10 cmH2O • PRONE IS CRUCIAL. • AVOID VILI and P-SILI • RECRUITMENT MANUEVER ONLY AFTER INITIAL INTUBATION AND AFTER ANY DISCONECTION • CORTICOSESTEROIS: THE “DRUG OF LIFE” IN COVID 19 PNEUMONIA only at anti-inflammatory doses ( Dexamethasone 6 mg / day: 1

31. Slide 31: Hope messages

    Hope messages  We have PPE: we have KN95 and face shields  know much more than in the first wave:  We know corticosteroids and low weight heparins work.  We know what doesn't work  We know the protocols in the ICU (NIV, prone position, bacterial infections,)  Immunity protection: at least 7 mo

32. Slide 32: Hope messages

    Hope messages  Protocols in restaurants works if people follow the roles  Teachers and parents are doing a great job !!!  Hot weather doesn't work at all  Indoor, not ventilated spaces, without masks are the most risk places = family parties, night parties, disco, etc.  Selective confinement wo

33. Slide 33: The only thing that can control this virus is confinement

    The only thing that can control this virus is: “CONFINEMENT” THERE ARE ONLY TWO OPTIONS: A)THE GOOD ONE: INDIVIAL (POSITIVES AND CONTACTS) + very strict control by the government (Asia-pacific, China stile) B)THE BAD ONE: GLOBAL (COUNTRY OR CITY) C)The more selective the better

34. Slide 34: Thank you

    + Ventimec Ventimec Thank you formación ventilacionanestesia@gmail.com www.ventilacionanestesia.com

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