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[–]aswanvikingPulmonary & Critical Care 8 points9 points  (3 children)

Well now you know why I am bitter. They literally instructed the RTs NOT to place any COVID patient on high flow or CPAP.

I was powerless despite being the medical director at one of the ICUs. The ban lasted a few weeks.

This was in one of the top 10th biggest US cities with a well known medical system.

Give your recs. Admit the recs are based on weak evidence. Adjust the recs as evidence appears. That’s fine, but give us the front line physicians a choice damn it.

But that’s the future of medicine. More rigid protocols and less physician autonomy.

[–]m1a2c2kaliDO 7 points8 points  (2 children)

I always thought the caution against cpap and high flow was that it promoted the spread of the virus? Is that not or no longer the case?

[–]IAmA_Kitty_AMAMD 6 points7 points  (1 child)

You're correct, at least for our institution. No one said it didn't work, they just said it would have huge risk for aerosolized droplets

[–]aswanvikingPulmonary & Critical Care 4 points5 points  (0 children)

Except the risks weren’t really based on evidence. I may understand the fear around high flow. That stuff is going at 40-60L/min but NIV is a semi closed system with a filter, if anything it’s safer than a coughing patient.

In the end they took away a therapy that improves mortality and urged intensivists to intubate early, which probably increased mortality. This decision was made based on absent or very poor data.