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Intensive Care / Anaesthesiology

Online Training and Research

NHS

Guidance from NHS England and NHS Improvement for the role and use of non-invasive respiratory support in adult patients with COVID19 (confirmed or suspected). Link.

Clinical guide from NHS England and NHS Improvement for the management of paediatric critical care patients during the coronavirus pandemic. Link.

Clinical guide for the optimal use of Oxygen therapy during the coronavirus pandemic. Advice provided on aim with respect to saturations. Link.

Clinical guide for renal replacement therapy options in critical care during the coronavirus pandemic. Advice on indications for renal replacement therapy and the various options to be considered if appropriate. Link.

Clinical guide for extra corporeal membrane oxygenation (ECMO) for respiratory failure in adults during the coronavirus pandemic. Guidance of the inclusion criteria for those that may be suitable candidates for ECMO. Link.

Clinical guide for anaesthesia service reorganisation during the coronavirus pandemic. Advice provided on how to manage workload and distribution of staff with respect to increased workload. Also includes ways in which to increase patient safety through effective organisation of teams and minimising non-essential contact between public, staff and patients. Link.

Clinical guide from NHS England and NHS Improvement for the management of critical care patients during the coronavirus pandemic. Link.

A Clinical guide from NHS England for the optimal use of Oxygen therapy during the coronavirus pandemic. Link.

Clinical guide for the management of critical care for adults with COVID-19 during the coronavirus pandemic. Link.

Awake Proning Guideline. Link.

Awake Proning Video. Link.

The Faculty of Intensive Care Medicine

Nasogastric tube placement checks before first use in critical care settings during the COVID-19 response. Guidance on the ‘four criteria’ that ought to be used when confirming NGT placement in COVID-19 patients. Link.

The Faculty of Intensive Care Medicine have signposted to various clinical guidance resources- including critical care, airways management and obstetric anaesthesia resources. Link.

Considerations for tracheostomy in the COVID-19 outbreak and balancing the risks of infection control risks of aerosol spread of the virus versus the best management for the patient with a tracheostomy. Guidance with respect to safety of patients and staff in cases of ventilated and non-ventilated tracheostomies and management of these patients. Link.

Templates that can be followed in various aspects of critical care including daily reviews of patients, admission guidance and transfer letters. Details on how to assess patients on a daily basis and advice on aspects of care that should be considered routinely. Link.

Principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. Recommendations on the prevention of contamination of healthcare workers, the choice of staff involved in airway management, the training required and the selection of equipment. The fundamental principles of airway management with respect to emergency tracheal intubation (summary provided); predicted or unexpected difficult tracheal intubation; cardiac arrest; anaesthetic care; and tracheal extubation. Link.

Advice for anaesthetists who undertake airway management in paediatric patients suspected or confirmed to have COVID-19 and seeks to provide clarity where that guidance differs from adult patients. Guidance on the process of tracheal intubation and extubation in paediatric care is provided so as to ensure safety and favourable outcomes. Link.

Confirmation of death in a positive or suspected Covid 19 patient. Discussion regarding the criteria for confirmation/verification of death in Critical Care setting and medical certification with respect to cause(s) of death. Link.

Intensive Care Society

A series of posters with the aim to improve understanding of psychological wellbeing at work, the impact reduced wellbeing can have and what can be done in response, and tips for dealing with extraordinary situations such as COVID-19 and everyday working in critical care. An insight into tips for approaching self-care, managing personal wellbeing, allowing for improvement of the workplace and when/where to ask for help. Link.

A guidance and resource library released by the Intensive Care Society which provides a range of international clinical guidance and resources relating to intensive care management during the COVID-19 pandemic. Link.

NICE – National Institute for Health and Care Excellence

The purpose of this guideline is to maximise the safety of patients who need critical care during the COVID-19 pandemic, while protecting staff from infection. Guidance is provided on admission to hospital and the use of clinical frailty score which can be particularly important in assessing those patients that may be suitable for escalation for treatment and/or admission to critical care whilst also providing recommendations with respect to clinical decision making in these situations and scenarios. Link.

Royal Free Anaesthetics

A video simulation demonstrating a safe method of intubation for a COVID-19 patient, including – 1) proper PPE use and team communication, 2) preparation of bougie, 3) adminstration of anaesthetic drugs, 4) recording patient observations, 5) laryngoscopy and insertion of bougie, and 6) confirmation of tube placement. Video by the Royal Free Anaesthetics Team. Link.

A step-by-step video guide on how to safely don Personal Protective Equipment by the Royal Free Anaesthesia Team. Guidance is according to Public Health England and Royal Free Hospital Trust guidelines. Link.

A step-by-step simulation of how to place a patient in prone position to optimise ventilation. It demonstrates the following – 1) ensuring no contraindications to proning, 2) going through the equipment checklist, 3) preparing the patient, 4) placing a slide mat whilst patient is supine, 5) proning, 6) prevention of pressure sores, 7) length of proning, and 8) how to reverse a prone patient. Video was filmed by the Royal Free Anaesthetics Team. Link.

A step-by-step video guide on how to safely remove and dispose of Personal Protective Equipment (doffing) by the Royal Free Anaesthesia Team. Guidance is according to Public Health England and Royal Free Hospital Trust guidelines. Link.

Wiley Online Library

This was an in-situ simulation of high-risk procedures on COVID-19 patients in a negative-pressure side room at the Royal Free Hospital’s Intensive Care Unit. The aim of the simulation was to identify potential problems, test the robustness of their systems, and modify standard operating procedures for COVID-19 patients. There were two simulated scenarios – 1) rapid sequence induction of anaesthesia and subsequent mechanical ventilation, and 2) proning of patient for optimisation of ventilation. The outcome identified active teamwork and communication failures as well as protocol and equipment issues. The team were able to put corrective measures in place rapidly and prepare staff for real patients. It ultimately provides an example of how in-situ simulations can identify operational readiness of ICU for admission of COVID-19 patients and how they can be used as the outbreak progresses to train more staff members. Link.

European Society of Intensive Care Medicine

Comprehensive guidance from the European Society of Intensive Care Medicine and the Society of Critical Care Medicine on the management of critically ill adults with COVID-19. Link.

Barts Health NHS TrustBarts Health NHS Trust

Coronavirus: extubation: Training video by Barts Health. Link.

Coronavirus: clinical assessment of a patient in ICU. Link.

Coronavirus: prescribing in critical care. Link.

Barts Health Trust video on initating patient mointoring for COVID19. Link.

EMCrit

BiPAP and CPAP. Link.

e-LfH – e-Learning for Healthcare

Arterial line e-learning. Link.

Edu Med

Video to summarise the latest ICNARC ICU data for UK Critical Care areas specific to COVID-19. Link.

Future Learn

Critical Care Online Resource . Link.

Airway Matters

Donning and doffing (UCLH) . Link.