Covid-19 Treatment Protocol

Being adequately equipped, trained and correctly informed to treat covid19 patients is no small matter.

Currently it is evident that According to the World Health Organization (WHO), some 80% of people with Covid-19 - the disease caused by coronavirus - recover without needing hospital treatment. But, one person in six becomes seriously ill. In these severe cases, the virus causes damage to the lungs, causing the body's oxygen levels to drop and making it harder to breathe.

Of patients hospitalized with COVID-19, 25% require ICU admission.
Profound hypoxemic respiratory failure from ARDS is the dominant finding in critically ill patients. Common complications include acute kidney injury (AKI), the late development of cardiac injury, sepsis, shock, and multi-organ failure 
For most critically ill patients with COVID-19, we prefer the lowest possible fraction of inspired oxygen (FiO2) necessary to meet oxygenation goals, ideally targeting a peripheral oxygen saturation between 90 and 96 %
The use of HFNC and NIV is controversial based on infection control concerns and the frequent need for mechanical ventilation despite these measures.  
In patients with COVID-19 who have acute hypoxemic respiratory failure and higher oxygen needs than low flow oxygen can provide, we suggest selective use of non-invasive measures like mHBOT rather than routinely proceeding directly to intubation .
Among the non-invasive modalities we suggest HFNC rather than NIV (Grade 2C). Our preference for HFNC is based upon limited and inconsistent data, which, on balance, favours HFNC compared with NIV in patients with non-COVID-19-related acute hypoxemic respiratory failure. NIV via a full-face mask (with a good seal) may be appropriate in patients with indications that have proven efficacy including acute hypercapnic respiratory failure from an acute exacerbation of chronic obstructive pulmonary disease, acute cardiogenic pulmonary edema, and sleep disordered breathing.  Patients with potential haemothorax should not receive mHBOT.

For critically ill patients with COVID-19, intubation should not be delayed until the patient acutely decompensates since this is potentially harmful to both the patient and healthcare workers. We have a low threshold to intubate those who have:
Intubation is a high risk procedure for aerosol dispersion in patients with COVID-19 and attention should be paid to donning full personal protective equipment (PPE) with airborne precautions as well using equipment that minimizes dispersion and the development of protocols for the procedure.
For patients with COVID-19 who fail LTVV, prone ventilation is the preferred next step 

Our recommendations for new Covid-19 Hospitals being planned.  
Studies show that leukocytes perform best at oxygen levels above 300 mmHg, levels only achievable with supplemental oxygen through HBOT.