The COVID19 pandemic poses a major challenge to the healthcare system in affected countries, and we have no reason to believe that Belgium will be different. Thanks to the work by our Chinese and Italian colleagues, we can project that possibly hundreds of patients will need intensive care in Belgium in the upcoming weeks.
Approximately 20% of COVID19 affected patients will require hospitalization. Approximately 5% will require intensive care. Each hospital will probably admit patients at a certain stage. Larger centers, and the 2 reference centers, will be asked to admit the more complex cases. We will need to help each other in solidarity. We ask our members to follow government guidelines, including complying with registrations. It is of utmost importance that our policy makers can have accurate numbers of the current situation in our country.
Most COVID19 patients admitted to an intensive care unit suffer from respiratory problems, and the management is not much different from other types of viral pneumonia, a condition that most of you will be familiar with. Some patients can be managed with high flow nasal oxygen, some require non-invasive ventilation, and about half of the ICU patients need to be intubated. Lung-protective ventilation with low tidal volumes are key, and high PEEP if necessary. Prone ventilation appears to be a successful strategy for hypoxia in the COVID19 cases. Steroids are not advised, because they might increase the risk of viral transmission and have no demonstrated benefit. A restrictive fluid management should be maintained. In addition, 40% of ICU patients will have a form of cardiac failure, indicating that the hemodynamic situation needs to be monitored closely. Additional problems are gastro-intestinal, secondary infections, and acute kidney injury. The links below provide specific guidance.
Please take care of yourself, and your co-workers. Use the appropriate personal protective equipment (PPE), certainly for procedures with a high risk of viral transmission, such as intubation. The government is doing a major effort to ensure enough PPE will be available, which is quite a challenge.
While the extend of what we may expect remains unknown, it is clear that we need to prepare. The SIZ is working closely with the federal government, and is in close contact with our international colleagues, to provide the Belgian intensive care community with the most accurate and up-to-date information. Let’s face this challenge together!
The SIZ board
PRELIMINARY DUTCH TREATMENT ADVICE