Perspectives on Cardiopulmonary Critical Care for Patients With COVID‐19: From Members of the American Heart Association Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation
Bibliographic record
Abstract
he coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), marks a global event that will permanently reshape implementation of intensive care medicine.As of June 4, 2020, there were 6 606 455 reported cases of COVID-19, including 388 556 fatalities spanning 215 countries and territories, although epidemiologic data remain incomplete.Early autopsy reports emphasize proximal airway and distal airspace involvement, including alveolar epithelial inflammation and capillary thickening.These processes appear to promote acute respiratory distress syndrome (ARDS) and increased susceptibility to cytokine storm, resulting in respiratory failure and circulatory collapse in severe cases.Cardiomyopathy (particularly myocarditis) and ventricular arrhythmia further complicate management.Indeed, the mortality among ventilated patients in the intensive care unit (ICU) is as high as 50% 1 ; thus, critical care medicine has emerged as a central focus of the COVID-19 clinical spectrum.Here, critical care medicine and other matters of cardiopulmonary health important to the COVID-19 pandemic are discussed. PATIENT ISOLATION AND PROTECTION OF HEALTHCARE WORKERSExposure to SARS-CoV-2 requires up to 14 days of quarantine, which significantly drains provider resources.Rational policies must balance the effort to reduce risk of virus transmission and quarantine with the supply chain analysis of current and future personal protective equipment (PPE) availability.This includes systems-based preparations that recognize and plan for the increased risk associated with aerosol-generating procedures (eg, endotracheal intubation, noninvasive positive pressure ventilation, high-flow oxygen therapy, jet nebulization, chest physiotherapy), including implementing droplet-level precautions under conditions in which PPE availability is limited.This also encompasses regular surgical masks on patients and providers in the inpatient and outpatient settings, 6-ft (1.8 m) distancing when possible, and gown-glove-hand washing with frequent sanitation of contact areas.Patients who are being investigated, who are hospitalized and awaiting nasal swab sample collection
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.007 | 0.013 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.003 |
| Scholarly communication | 0.004 | 0.007 |
| Open science | 0.001 | 0.003 |
| Research integrity | 0.011 | 0.013 |
| Insufficient payload (model declined to judge) | 0.014 | 0.003 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".