ICU Lessons on COVID-19 From Italian Front Line: Be Flexible

CPAP, which can be performed by nurses, can help reduce the number of patients requiring intubation and so save ICU beds for those who really need them.

A limiting factor, however, in using CPAP may become the oxygen pressure in distribution lines.

Rationing ICU Beds: “Now They Have to Choose”

These latest Italian data also indicate that ICU beds are being rationed, with patient age a commonly used criterion for selecting patients, Manca explained.

“Medical doctors swear to treat everybody independent of their age, sex, gender, religion, and so on,” he added, “but now they have to choose.”

The UK National Institute for Health and Care Excellence (NICE) published a COVID-19 rapid guideline on critical care on March 21, which emphasizes all patients be assessed using a recognized frailty score before being directed to intensive care.

Manca agreed with this approach, saying the crisis has meant each hospital in Italy is having to create its own rules for ICU admission, with the selection based on physical status now a commonly employed criterion.

The Illusion of Steady-State Admissions

Finally, Manca warned that in regions of Italy where the numbers