Medtronic Plc. · NYSE:MDT
Medtronic — Investor Presentation (2020)
25 slides from Medtronic's investor presentation, 2020
Slide 1: Soporte Respiratorio en Paciente COVID-19
Soporte Respiratorio en Paciente COVID-19 Carlos Ferrando MD, PhD, DESA Head of Surgical Intensive Care Unit Anesthesia and Critical Care Department Hospital Clínic Barcelona, Spain CIBER of Respiratory Disease ISCIII, Spain mail: cafeoranestesia@gmail.com UC202014848 ES Twitter: @cafeoranestesia
Slide 2: First line therapy Livesaving therapy
First line therapy Livesaving therapy
Slide 3: Clinical characteristics of deceased COVID-19 patients (Chen, BMJ 2020)
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study Table 1 | Presenting characteristics of patients with coronavirus disease 2019 who died and recovered patients. Values are numbers (percentages) unless stated otherwise Total (n=274) Deaths (n=113) R
Slide 4: Laboratory findings on admission, deceased vs recovered (Chen, BMJ 2020)
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study Table 2 | Laboratory ndiags on adession of palons with cornavius disease 2019 who ded and vecovered patients Values arenambers (ercentages unless stated otherwise aber Rng (normal ange) ‘apna eat) Re
Slide 5: Risk factors for ARDS and death in COVID-19 pneumonia (Wu, JAMA)
JAMA Internal Medicine | Original Investigation Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China RESULTS Of 201 patients, the median age was 51 years (interquartile range, 43-60 years), and 128 (63.7%) pati
Slide 6: Insuficiencia Respiratoria Aguda
Insuficiencia Respiratoria Aguda
Slide 7: CT images of fatal cases (Chen, BMJ 2020)
Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study A Fatal case 1 First CT B Fatal case 1 Second CT C Fatal case 2 First CT D Fatal case 2 Second CT Chen T, et al. BMJ 2020
Slide 8: Gattinoni lung damage progression
lung damage progression (Virus + P-SILI) Type L Low elastance Non invasive sanheith : Early intubation Late intubation Low VA/C mismatch supe Type H Low lung weight HEN PEEP (5-10 cmH,0) Higher PEEP (10-15 cmH,0) High elastance Low recruitability | CPAP i L Prone position High R-L shunt NW NMBA (ECM
Slide 9: Characteristics and outcomes of 1591 ICU patients in Lombardy (Grasselli, JAMA)
JAMA | Original investigation Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy Table 1. Demographic and Clinical Characteristics of Patients in the First 24 Hours of ICU Admission for COVID-19 in Lombardy, Italy Patients b
Slide 10: Invasive vs. Non-invasive ventilation in ARDS
Invasive vs. Non-invasive N = 29.144 -- 3022 with ARDS Bellani G, et al. Am J Respir Crit Care Med 2017
Slide 11: COVID-19 initial management: high flow nasal therapy
COVID-19 INITIAL MANAGEMENT High Flow Nasal Therapy Respiratory Support PaO2/FiO2 or SpO2/FiO2 > 150 mmHg PaO2/FiO2 or SpO2/FiO2 = 100 - 150 mmHg HFNT 50-60 lpm FiO2 for SpO2 > 90% HFNT 50-60 lpm FiO2 for SpO2 > 90% Monitor Closely. Consider the ROX index Monitor Closely. Consider the ROX index SpO2
Slide 12: COVID-19 initial management ICU patients outcomes
COVID-19 INITIAL MANAGEMENT 514 ICU Patients 9 No COVID 505 ICU Patients 4 alta/éxitus día 0 501 ICU Patients 49 No datos 452 ICU Patients 30% 136 ICU Patients 316 ICU Patients Éxito de terapia del 85% HFNT + Prono = 27.5% https://covid19.ubikare.io/
Slide 13: Basing respiratory management of coronavirus on physiological principles
Basing Respiratory Management of Coronavirus on Physiological Principles The decision to institute invasive mechanical ventilation (involving an endotracheal tube) is based on physician judgment—clinical gestalt influenced by oxygen saturation, dyspnea, respiratory rate, chest x-ray, and other facto
Slide 14: ¿Cuándo iniciamos la VMI?
¿Cuándo iniciamos la VMI? 316 136 Pendiente análisis de hallazgos radiográficos
Slide 15: Paso 1: Ventilación protección pulmonar
SERVICIO ’ : BHESTERIGTOCIAY g PASO 1: VENTILACION PROTECCION REANIMACION OBJETIVO ee <p01 88-90% necoseet PROTECCION DP <15 PaO2 55 - 85 pH > 7.20 PULMONAR | VT 6 ml/kg de peso corporal ideal. F R para mantener PH objetivo. - Hombre: 50 + 0.91 (altura — 152,4) FR > 25-27 dejan de ser efectivas F iO
Slide 16: Evolución volumen tidal en primeros días de VMI
Evolucién Vol Tidal aj primeros 7 dias VMI 10 Evoluci6n Vol Tidal ajustado - VMI Media, IC 95%. a 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 6 T T T ga 1 2 3 4 5 6 7 dia © Extubados<7d —®~ Fallecidos<7d + —®— Intubados hasta ol dia 7
Slide 17: Paso 2: PEEP óptima, reclutamiento y RNM
PASO 2: PEEP OPTIMA +/-RECLUTAMIENTO + CONSIDERAR RNM PRIMERA MANIOBRA Ventilacién en presién Control PCV con Pi 15 cmH20 FR1S // 1:£1:2 // PEEP igual INCREMENTO PEEP de 5 en 5 cada 30 s hasta PEEP 25-30 ( VIGILA! Tolerancia Hemodinamica). Mantener ultimo paso 2 minutos. CALCULO PEEP OPTIMA 1. Ajust
Slide 18: Evolución PEEP en VMI
4 Evolucién PEEP - VMI 7 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 dia Media, IC 95% 8 Evolucién PEEP primeros 7 dias VMI 2 3 4 5 6 7 dia —@- Extubados<7d —®- Fallecidos<7d —@~ Intubados hasta el dia 7
Slide 19: OLA-Strategy vs ARDSnet-Strategy
End-inspiration Overdistension region OLA-Strategy Lung Volume protective “zone” Collapse ARDSnet-Strategy region Pressure Pressure End-espiration
Slide 20: Paso 2: PEEP óptima, reclutamiento y RNM
PASO 2: PEEP OPTIMA +/-RECLUTAMIENTO + CONSIDERAR RNM PRIMERA MANIOBRA Ventilacién en presién Control PCV con Pi 15 cmH20 FR15 // 1:E1:2 // PEEP igual 1 ASEGURAR INCREMENTO PEEP de 5 en 5 cada 30 s hasta PEEP 25-30 ( VIGILA! Tolerancia Hemodinamica). Mantener ultimo paso 2 minutos. 1 1 1 Estabilidad
Slide 21: PETAL Clinical Network. New Eng J Med 2019
PETAL Clinical Network. New Eng J Med 2019
Slide 22: Paso 3: Ventilación en decúbito prono
PASO 3: técnica 1. Colocar “Galina B vias/sondas/drenajes/T ewan —(O) & faa nwo — (gc ubuladuras 5 g H PASO 3: VENTILACION EN DECUBITO PRONO . é PRONO Si 4-6 H posterior a PASO 1 y 2 NO Conseguimos objetivos de CUANDO? ventilacién protectora o PAF! < 150 3. Desplazar al lado contrario del giro oF Po
Slide 23: Guerin C et al. New Eng J Med 2013
Guerin C et al. New Eng J Med 2013
Slide 24: Recomendaciones
RECOMENDACIONES Iniciar terapia con alto flujo y/o VMNI de manera precoz PERO valorar la IOT de manera continua OBJETIVOS VMI: 1. Protección pulmonar: Presión meseta < 28 cmH2O + driving pressure < 15 cmH2O 2. Oxigenación: SpO2 88-92% -- PaO2 55 - 85 mmHg 3. Ventilación: PaO2 < 60 mmHg, pH > 7.20 •
Slide 25: Thank you in multiple languages
=gi=qs Ngiyabonga ec dankesi. eseliuredtins x thank yo ygijiaclase = naa! thalalani p “el [Pesta oigado= 42 hee ial ese TET S w