ESAIC Academy

Summary: ESA Webinar series on COVID-19: 5th Episode: Sedation, Fluids and Transfusion, Haemostasis and Thrombosis
Dr. Hans-Christian Zaun, Ph.D.
Scientific Advisor, MULTILEARNING GROUP.

This fifth of a series of COVID-19 webinars on sedation, fluids and transfusion, haemostasis and thrombosis is hosted by Prof. Dr. Ilona Bobek, of the Department of Anaesthesiology and Intensive Care Medicine, Budapest, Hungary.  Scientific Faculty Leader is Prof. Dr. Marcelo Gama de Abreu of Department of Anesthesiology and Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Germany.
Prof. Vincent Bonhomme of the University Department of Anesthesia and Intensive Care Medicine, CHR Citadelle and CHU Liege, Liege, Belgium, begins by reviewing sedation of COVID-19 patients. Currently, there is no literature available, so we must rely on expert opinions. Fortunately, sedation in COVID-19 is a rare occurrence. He recommends postponing procedures for 14 asymptomatic days whenever possible. However, general anesthesia with intubation is possible, and he also reviews some alternative options. Prof. Bonhomme discusses precautions to protect both patients and staff, which include proper testing, designated COVID-19 areas and recommendations for patient transport. He emphasizes adequate preparation and planning, especially preparing for worst-case scenarios. On the topic of medication choice, Prof. Bonhomme, recommends using the same medications as routine practice and reviews the advantages and disadvantages of several of them. He concludes by discussing patient monitoring and reviews recommendations for the postoperative period and pain management.

Then Prof. Thomas Scheeren from the Department of Anesthesiology, University Medical Center Groningen, the Netherlands, who discusses fluid management and transfusion of COVID-19 patients. He briefly reviews the clinical manifestation of COVID-19 in the lungs and the hemodynamic consequences that may lead to respiratory shock, renal failures and, ultimately, multiple organ failure and death. After reviewing both the positive and negative effects of restricting or administering fluids, Prof. Scheeren reviews his recommendations for fluid management in COVID-19 patients, including a restrictive fluid regimen to avoid lung edema, preventing hypovolemia and ensuring adequate RV load. However, he emphasizes that fluid responsiveness requires monitoring and give fluid when needed. To this end, there are clear recommendations from the Surviving Sepsis Campaign as well as the NIH, and he reviews numerous protocols and recommendations. However, regarding the limitations for COVID-19 patients. Dr. Scheeren emphasizes that one must be aware of both false positives when assessing patients with dynamics variables and looks at possible solutions. Finally, when discussing which fluids to use, there are also clear recommendations from the Surviving Sepsis campaign and the NIH, which he reviews. 

Finally Prof. Marc Samama of the Department of Anaesthesiology & Intensive Care, Cochin University Hospital, France, discusses the critical issue of haemostasis and thrombosis in COVID-19 patients. He reviews the literature regarding clinical manifestations and COVID-19 as a severe prothrombotic disease. He discusses evidence of the possible mechanisms that pointing to COVID-19 being inflammatory microangiopathy. He continues by demonstrating that among the hemostatic parameters, fibrinogen and D-dimers are predictive of increased mortality. However, he does not believe the use of viscoelastic tests is useful. 

The webinar concludes with closing remarks from both Prof. Gama de Abreu and Prof. Bobek, inviting participants to join the next webinar on COVID-19, where we will hear from patients, members of the media and industry partners about their experiences in dealing with the COVID-19 pandemic.

This webinar will enable caregivers of patients with COVID-19 to:
• Choose appropriate sedation techniques and monitoring
• Conduct and monitor fluid and transfusion on an individual basis and according to pathophysiological particularities
• Describe disease-specific implications for haemostasis and thrombosis, and apply differentiated algorithms for phophylaxis and treatment

Practical skills to be acquired after attending this Webinar:
The user can:
• Conduct most appropriate sedation techniques in this population
• Guide fluid and transfusion therapy that is tailored to individual needs
• Diagnose and manage the hypercoagulable status

Affective skills acquired after attending to this Webinar:
The user is aware of:
• Objective and safe handling in this population
• Unique needs of COVID-19
​• Expert recommendations based on pathophysiological rationales and clinical experience