In a world of information overload, this post is intended to provide ICU staff with links to certifiable COVID-19 information that is being updated regularly. Both general information and St Vincent’s Melbourne ICU specific information is provided. This information will be updated as best possible (last update 4-10-2021). Please notify of any areas to be updated or improved on.

Useful links

COVID-19 presentation

Clinical features/investigation findings – UpToDate

Radiological features – Radiopaedia

COVID-19 testing criteria and clinical advice

Assessment and testing – Department of Health and Human Services (DHHS) Victoria

Clinician advice – Department of Health and Human Services (DHHS) Victoria

COVID-19 planning and safe working

The document below is an operational guide for ICUs within Australia and New Zealand on unit preparations and maintenance of a safe working environment for staff. Available at https://www.anzics.com.au/coronavirus-guidelines.

COVID-19 management

Severe disease –

The provided National COVID-19 Clinical Evidence Taskforce document is a framework to base recommendations on that we are looking at but please refer to your own local guidelines and Clinicians for specific management advice. Sourced from https://covid19evidence.net.au.

Dexamethasone (6mg IV daily for 10 days) for patients requiring ICU with COVID-19. Evidence is suggestive of a mortality benefit in those who require supplemental oxygen or ventilation.

Normal dosing of prophylactic anticoagulation with subcutaneous Enoxaparin unless diagnosis of thromboembolic event.

There are various novel agents available. Consider the use of Sotrovimab, Regen-COV, Tocilizumab and Baracitinib/Sarilumab in appropriately selected patients as per discussion with Infectious Disease team.

See ‘Specific management at St Vincent’s’ below regarding Nebulised Heparin.

COVID-19 data

Australian sources – COVID-19 Data and COVID Live

International sources – Worldometers and WHO dashboard

St Vincent’s Melbourne ICU initiatives

Infection control (Personal Protective Equipment)

• It is important that our staff follow the guidelines set out for the Department of Critical Care Medicine which is in turn guided by the DHHS and St Vincent’s Hospital Melbourne. Different hospital departments may have different PPE protocols – please only refer to the guidelines the Department of Critical Care Medicine releases if you are working with us.
• Level 4 PPE should be worn for all confirmed or suspected COVID-19 patients. Currently (as of 4/10/21) we are also wearing N95 and goggles in all clinical areas.
• The guideline below is also available on the ICU sharepoint and intranet under Intensive Care Unit/Policies & Guidelines – COVID 19 Resources). The colour coding of sections of the checklist correspond with the larger visual aids to guide the steps of donning and doffing. It is integral that you read the checklist and have a doffing spotter.
• All staff are expected to be able to don and doff safely. Education has been rolled out by Lauren & Liz (education nurses). You will not be expected to look after confirmed or suspected COVID-19 patients without sufficient PPE.

Ventilator education and setups

• Visit the Ventilator Training Alliance website to download apps for iPhone or Android centralising education for different ventilator types.
• See below to download our pictorial COVID-19 ventilator setups for the Drager (Evita XL/V500) and Hamilton (T1/C6) ventilators. These setups are aimed at reducing the risk of disconnection and viral particles reaching the atmosphere. In addition, you will find descriptions of each viral filter/HME in use at SVHM ICU.
• For more information contact: Nursing – Gary, Karl, Anthony, Medical – Tim, John, Barry.

In house staff training

• Journal Club and Registrar teaching schedules are available on the ICU sharepoint.
• Keep an eye out for correspondence for in house ECMO or COVID simulations.

Intubation and extubation

• The COVERT team is currently not in use but may be reinstituted. The guideline can be accessed here: Sharepoint COVID-19 site (SVHA login is required, can access remotely).
• Intubation and extubation guideline for COVID/sCOVID patients:

Triaging during the pandemic

• A collaboration between ICU, General Medicine, Respiratory, Palliative Care, ED and Ethics to provide guidance in patient disposition and appropriate levels of care during the pandemic.
• Available on the ICU sharepoint or intranet under Policies–COVID-19 Policies–Intensive Care or the Sharepoint COVID-19 site (SVHA login is required, can access remotely). For internal use only.
• For more information, contact Patricia or Steve.

Proning

• Proning blog post and instructional video (for more information contact Steve, Patricia, Liz or Lauren – education nurses).
• If numbers of patients who require proning is significant then a proning team will be designated at the start of each shift to prone and de-prone patients.

Workforce & upskilling

• Extensive planning is in place for transition from normal rostering to pandemic rostering for both nursing and medical staff (senior and junior). We are taking staff safety and rostering sustainability very seriously. For more information: Medical staff – contact Patricia or Steve, Nursing staff – contact Crystal or Philippe.
• In addition, some Anaesthestists, Anaesthesia registrars and Nurses from Anaesthesia/PACU/4th floor may get re-deployed with ICU orientation/upskilling to allow them to function as part of a wider critical care team.

Workflow and documentation

• If and when we enter ‘pandemic rostering’, staff will attend work at their allocated times, attend a central ‘huddle’ (appropriate social distancing!) and be allocated to roles/areas based on need, clinical skill mix and phase of the pandemic.
• Documentation will continue on ICCA in new extended ICU areas.

Equipment & drugs

• CVC, arterial line, IDC and intubation packs will be created if the need arises. For more information contact Patricia or equipment nurses.
• Sonosite iViz hand held ultrasounds are available.
• There is adequate supply of PPE, ventilators, consumables and drugs. This is continuously being reviewed.

Organisational

• St Vincent’s Hospital Melbourne and St Vincent’s Private Hospital (Fitzroy campus) will continue to work closely together. This will involve movement of COVID cleared patients to the private hospital such as Cardiac Surgery patients.
• A live Victorian database is providing us with a snapshot of COVID-19 patients and other resource use in the ICUs around the state.

Specific management at St Vincent’s

• In addition to the recommended management above, the additional initiatives at St Vincent’s currently include:
  • CHARTER study: nebulized heparin – contact Barry Dixon to discuss. Patients are being recruited around Melbourne and expanding outside of the state of Victoria.

Staff support

• Staff call centre advice line: 1800 444 511.
• STAR team – contact Dave Reid on ST30 pager.
• Medical and nursing staff are encouraged to contact their ANUM/NUM (for nurses) or Consultant (for doctors).