Basics of Mechanical Ventilation for the COVID-19 Patient Financial Disclosures None Talk Objectives • discuss the rationale of positive pressure ventilation for patients with ARDS secondary to COVID-19 ntilation Protocol Summary PEEP 14 14 14 16 18 24 O2 Fi Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology Am J Respir Crit Care Med. 2020 Jul 1;202(1):1-4. doi: 10.1164/rccm.202004-1385ED. Author Hannah Wunsch 1 2 3 Affiliations 1 Department of Critical Care Medicine Sunnybrook Health Sciences. Oxygenation and Ventilation. Last Updated: December 17, 2020. The COVID-19 Treatment Guidelines Panel's (the Panel's) recommendations below emphasize recommendations from the Surviving Sepsis Campaign Guidelines for adult sepsis, pediatric sepsis, and COVID-19.. Nonmechanically Ventilated Adults With Hypoxemic Respiratory Failur COVID-19 Ventilation Protocols . 05/26/2021 1 . Studies have shown that COVID -19 is spread primarily through respiratory particles. Effective ventilation, along with other preventive measures, can be useful in preventing the virus' transmission through small aerosol particles
1.I understand that this protocol was developed by the Toronto Center of Excellence in Mechanical Ventilation (CoEMV) and should not be used alone to guide patient care, nor should it replace clinical judgment. This tool provides guidance for initial ventilation management in COVID-19 patients. It. The COVID-19 pandemic has cast a spotlight on ventilators—but few know much about what they do or how they work.. A ventilator pumps air—usually with extra oxygen—into patients' airways when they are unable to breathe adequately on their own. If lung function has been severely impaired—due to injury or an illness such as COVID-19 —patients may need a ventilator COVID-19: Revisiting ventilator protocol. Melissa Sammy, MDLinx | April 8, 2020. Across the nation, government leaders and hospital systems have voiced the urgent need for more ventilators to meet the challenge of the increasing number of critically ill patients with COVID-19. But, with emerging evidence showing a significant percentage of. COVID-19 who require mechanical ventilation or ECMO 2. Recommended for patients on supplemental oxygen. The benefit of dexamethasone is uncertain in adults on minimal protocol but has not been established for COVID-19 Weigh risks/benefits of use on a case-by COVID-19 ARDS Ventilator PEEP Titration Protocol Purpose • The purpose of this protocol initiated by an ordering provider, will allow the Licensed Respiratory Care Practitioner (LRCP) the ability to titrate rate, PEEP, tidal volume (Vt) and F I O 2. • Goal: PaO 2 55-80 mmHg and/or SpO
Invasive Mechanical Ventilation for Covid-19-Related Respiratory Failure. As shown in Panel A, a life-threatening problem in the purple box or a combination of less severe problems in the purple. Ventilator Use and Allocation: Key Considerations and Examples . March 23, 2020 (Updated as of 10 a.m. ET) OVERVIEW. Mechanical ventilation is a life-saving measure for people experiencing respiratory distress from trauma or severe respiratory conditions and diseases affecting lung function. Hospitals, acute care settings, an . This will STOP the flow from the ventilator to avoid aerosol spray from the circuit Forty-two recovered COVID-19 patients (33 men and 9 women) weaned from mechanical ventilation with a mean age of 48.05 ± 8.85 years were enrolled in this pilot control clinical study. Twenty-one patients were equipped to 2-week IMT (IMT group) and 21 matched peers were recruited as a control (control group)
Ventilation and air conditioning during the coronavirus (COVID-19) pandemic. 1. Overview. The law says employers must make sure there's an adequate supply of fresh air (ventilation) in enclosed areas of the workplace. This has not changed during the pandemic This post was updated on October 24, 2020, and March 10, 2021. The term proning has become common in journal articles and YouTube videos about the in-hospital ventilation of patients with COVID-19 disease. Because proning, and in particular awake proning, is becoming a familiar part of treatment protocols for COVID-19, we offer here a consideration of its origin and application . COVID-19 results in a dysregulated and exuberant immune response. Patients requiring intensive care have significantly higher levels of IL-6, IL-10 and TNFα and fewer CD4+ and CD8+ T cells. Downregulating the cytokine storm is an essential component of the treatment of severe COVID-19 disease. 4 Before COVID-19: what do we know about Mechanical Ventilation? Mechanical Ventilation is well-known for helping patients who are suffering from aspiration pneumonia, chronic obstructive pulmonary.
in patients with COVID-19; however, use of the Bundle should be encouraged, when appropriate, to improve ICU patient outcomes. Prolonged mechanical ventilation of COVID-19 patients, coupled with deep sedation and potentially neuromuscular blockade, increases the workload of ICU staff Successful adherence to a VT-focused ventilator order set further supports the feasibility of protocol-driven ventilation in the ED . Implementation of a similar mechanical ventilation protocol in an academic ED increased ventilator-free days and hospital-free days while being associated with significantly decreased hospital mortality  Michela Botta and colleagues described ventilator management in a large cohort of patients with COVID-19 on mechanical ventilation. 1 Their study provides important data on ventilator settings in this population and shows that high tidal volumes on the first day of ventilation are associated with a higher risk of 28-day mortality NAF. The Nigerian Armed Forces has produced a digital mechanical ventilator known as DICOVENT as well as several other COVID-19 essential and life saving equipment to manage the pandemic
COVID-19 should be treated with supportive and management therapies, as described below, taking into account the most will require mechanical ventilation (2, 10). The most common diagnosis in severe COVID-19 patients is according to local/regional public health protocols for home isolation and return to a designated COVID-19 hospital if. COVID-19 patients appear to require mechanical ventilation longer than other patients (eg, two to three weeks), but can still be successfully extubated after this point. Procedure - Tracheostomy is considered a high risk procedure for aerosolization. • Both open and percutaneous tracheostomy procedures are acceptable in COVID patients
Ventilator Sharing: Dual-Patient Ventilation with a Single Mechanical Ventilator for Use during Critical Ventilator Shortages NewYork-Presbyterian and Columbia University Vagelos College of Physicians and Surgeons share this protocol with our health care colleagues to increas Regardless of whether COVID-19 behaves like ARDS or not, we as physicians have been thinking about judicious use of mechanical ventilation for several decades, William Checkley, MD, PhD, a. COVID-19 Response . Mechanical Ventilation (HVAC) Systems . July 28, 2020 . There is limited scientific data concerning the spread of SARS-CoV-2 (COVID-19) through building heating, ventilating and air conditioning (HVAC) systems. The Centers for Disease Control (CDC Course description. This course will help prepare licensed non-ICU hospital clinicians to assist in the operation of a ventilator. Given the increasing number of patients contracting COVID-19 and developing pneumonia, the medical system is, and will continue to be, in dire need of licensed medical professionals who can assist in the operation of mechanical ventilators
Note that (regardless of COVID-19) CCR Title 8, Section 5142, requires that mechanical ventilation systems be maintained and operated to provide at least the quantity of outdoor air required by the State Building Standards Code, Title 24, Part 2, California Administrative Code, in effect at the time the building permit was issued Ensuring proper ventilation with outside air can help reduce the concentration of airborne contaminants, including viruses, indoors. However, by itself, increasing ventilation is not enough to protect people from COVID-19. When used along with other best practices recommended by CDC and others, increasing ventilation can be part of a plan to. The novel coronavirus disease (COVID-19) has exposed critical supply shortages both in the United States and worldwide, including those in testing capacity, intensive care unit (ICU) and hospital bed supply, hospital staff, personal protective equipment (PPE), and mechanical ventilators for affected regions ().The illness has been projected without preventative action to be able to affect 40%. Approximately 17-35% of hospitalized COVID-19 patients are admitted to an intensive care unit, primarily due to hypoxemic respiratory failure. 4 Greater than 75% of hospitalized COVID-19 patients require the administration of supplemental oxygen and 3-15% of COVID-19 patients will require mechanical ventilation. 1, 8 An early report indicated that death was common in patients who were.
mechanical ventilation) Respiratory Care Practitioner (RCP) to choose one of the following devices for transport according to patient clinical need and in accordance with recommendations outlined in COVID-19 Airway Oxygen NIPPV and Ventilator Guidelines. Patient must wear surgical mask over cannula, nose, and mouth ID/COVID-19 : Consult ID for If there is nothing else for you to do in the patient room, continue with doffing as per protocol; If there are additional needs at that time within the room, don a new pair of outer nitrile gloves to complete necessary tasks, then doff per protocol The goal of mechanical ventilation is to provide adequate.
But for COVID-19, the numbers are even worse. Only a small portion of COVID-19 patients get sick enough to require ventilation—but for the unlucky few who do, data out of China and New York City. Most cases of COVID‑19 are not severe enough to require mechanical ventilation or alternatives, but a percentage of cases are. The type of respiratory support for individuals with COVID‑19 related respiratory failure is being actively studied for people in the hospital, with some evidence that intubation can be avoided with a high flow nasal cannula or bi-level positive airway pressure Background Observational studies have consistently described poor clinical outcomes and increased ICU mortality in patients with severe coronavirus disease 2019 (COVID-19) who require mechanical ventilation (MV). Our study describes the clinical characteristics and outcomes of patients with severe COVID-19 admitted to ICU in the largest health care system in the state of Florida, United States . NewYork-Presbyterian and Columbia do not warrant the contents or effectiveness of the protocol, and the use and implementation of this protocol should be first reviewed and evaluated with each hospital's medical staff
Analgesia and Sedation in Patients with COVID-19 Approximately 14 percent of patients with COVID-19 infection experience a severe form of hypoxic respiratory failure, with 5 percent requiring mechanical ventilation.1 The dyspnea, air hunger, physical discomfort of being intubated, and need to prevent self-extubation have made sedation of thes Duke Health Tracheostomy Protocol During COVID-19 • For patients who have tested positive for COVID-19 within the last 90 days, pre- tracheostomy tube to mechanical ventilator. o Avoid respiratory circuit disconnections. o Suction only via closed circuit Search COVID-19 Rapid Resource Center or explore resources sorted by Category or Content Type. COVID-19 Rapid Resource Center > Mechanical Ventilation Mechanical Ventilation Main Content UMMC Elective Tracheostomy Protocol during COVID-19 Pandemic. Last update: April 10, 2020 Institutional practice guidelines for the indications and performance of tracheostomy during COVID-19 crisis help achieve a reasonable balance between need to protect health care staff during these high-risk procedures and the utilization of limited institutional resources
. In early April, New York Gov. Andrew Cuomo said that 80% of patients placed on ventilators in his state were dying. As the pandemic progressed, estimates were lower, ranging from 30 to 70%, depending on the hospital • Telecommunicators, consistent with local protocols, should screen all calls for COVID-19 symptoms (eg, fever, cough, shortness of breath) or known COVID-19 infection in the victim or any recent contacts, including any household members. o For lay rescuers, telecommunicators should provide guidance about risk of exposure to COVID-19 for Early series suggested high mortality for patients with COVID-19-associated respiratory failure who received invasive mechanical ventilatory support, 7 raising the concern that these patients may be particularly vulnerable to ventilator-induced lung injury. In addition, the surge of patients in some locales has already strained and exceeded. This Master Protocol is a randomized, placebo-controlled trial of agents targeting the host response in COVID-19 in hospitalized patients with hypoxemia. The Master Host Tissue Protocol is designed to be flexible in the number of study arms, the use of a single placebo group, and the stopping and adding of new therapies This protocol eventually spread throughout the world and became the standard of care for all forms of ARDS; it was even extended to non-ARDS-related mechanical ventilation. The advent of SARS-CoV-2 and COVID-19 added to the myriad causes of ARDS, and, not surprisingly, ARDS-based protocols were employed in those who required mechanical ventilation
Preventive dental visits reduce risk of ventilator-associated pneumonia, which poses a serious problem for those afflicted with COVID-19 and reliant on mechanical ventilation. The DentaQuest Partnership for Oral Health Advancement , today released a report that reinforces the connection between oral health and overall health, and underscores. The mortality rate among 165 COVID-19 patients placed on a ventilator at Emory was just under 30%. And unlike the New York study, only a few patients were still on a ventilator when the data were. Even as the number of hospitalized COVID-19 patients has grown, doctors have managed ventilator usage. As of Wednesday, UChicago Medicine had 137 COVID-19 patients, but only 27 of them were on ventilators. The medical staff has avoided mechanical ventilation on 40% of patients, and extubated 50% of those who needed ventilators, O'Connor said New COVID-19 HOPE Clinical Trial Recommendations Introduced Today May Reduce or Eliminate Mechanical Ventilation for Coronavirus Patients Published: Mar 30, 2020 Crucial life-saving initiative led by Dr. Steven Quay for clinical trials on the safety and efficacy of a combination of FDA-approved drugs (nebulized H eparin-N-acetylcysteine in C O.
Disclaimer: We aim to present our recommendations and a forum for questions. Given the novelty of COVID-19, best-available clinical evidence is supported from anecdotal reports from China, South Korea, Italy and previous epidemics like SARS and MERS Materials and Methods. In this retrospective study, clinical and imaging data of patients seen between March 1, 2020, and April 6, 2020, who tested positive for COVID-19 and experienced barotrauma associated with invasive mechanical ventilation, were compared with patients without COVID-19 infection during the same period For these protocols to work effectively, however, health systems and clinicians need to know what allocation decisions will actually save the most lives. Early in the trajectory of covid-19, there was little evidence on what affected prognosis. Ventilation of patients with covid-19 was rightly thought to facilitate positive outcomes During the same period, 196 patients without COVID-19 (average age, 64 years, 52% men) with invasive mechanical ventilation had one barotrauma event (0.5%) (P < .001 vs the COVID-19 infection group)
We present the first-ever reported case of massive epistaxis following nasopharyngeal (NP) swabbing requiring intubation and tracheostomy. A 67-year-old male with a mechanical aortic valve on warfarin presented from a nursing home to the emergency department with hypoxia. NP swab for coronavirus disease 2019 (COVID-19) was obtained, immediately followed by significant epistaxis as a Treatment for Patients with COVID-19 Associated Acute Respiratory Distress Syndrome (ARDS) on Mechanical Ventilation - Improvement in mortality for each dose compared to placebo, while. Experts Demystify Covid 19 Treatment Protocols. 28/05/2021 | Featured, Professionals, Public, Uncategorized, Videos. A discussion on Covid19 Management. Experts- Professor Randeep Guleria, Director, AIIMS, Delhi & Professor Nicholas Hart, Clinical Director, Guy's and St Thomas' NHS Foundation Trust, London .
The COVID-19 pandemic reached Europe in early 2020. Convalescent plasma is used without a consistent evidence of efficacy. Our hypothesis is that passive immunization with plasma collected from patients having contracted COVID-19 and developed specific neutralizing antibodies may alleviate symptoms and reduce mortality in patients treated with mechanical ventilation for severe respiratory. To the Editor: The Journal recently published two trials of tocilizumab for coronavirus disease 2019 (Covid-19) (Dec. 10 and Jan. 7 issues).1,2 According to the articles, the primary outcome in bot.. Transcutaneous Vagus Nerve Stimulation is Associated with Lower Mechanical Ventilation and Mortality in COVID-19 Patients. Patrick Nemechek 1* Guido Antonelli 2 Ariel Braida 2 . 1 Nemechek Autonomic Medicine, Buckeye Arizona, USA 2 Hospital Zonal Virgen del Carmen de Zárate, Zárate, Buenos Aires, Argentina.
- Expanded Access Protocol (EAP) Included 240 ICU Patients Suffering Critical COVID-19 with Respiratory Failure who had Exhausted All Approved Therapies - Survival was Higher in those Treated with High Flow Nasal Cannula than those Treated with Mechanical Ventilation (76% vs. 54% COVID-19 pandemic on non-COVID-19 clinical trials. J Am Coll both trials was mechanical ventilation or death. comparison of protocols to published arti-. 56 - 7542 : 192 AM; 20 4J 0 s. e l. Objectives. To determine if a specific intervention reduces the composite of progression of patients with COVID-19-related disease to organ failure or death as measured by time to incidence of any one of the following: death, invasive mechanical ventilation, ECMO, cardiovascular organ support (inotropes or balloon pump), or renal failure (estimated Cockcroft Gault creatinine clearance <15ml/min)
• SCCM Surviving Sepsis Guidelines Management of COVID-19. 2020 • Schmidt GA, Girard TD, Kress JP, et al. Official Executive Summary of an American Thoracic Society/American College of Chest Physicians Clinical Practice Guideline: Liberation from Mechanical Ventilation in Critically Ill Adults. Am J Respir Crit Care Med Ventilation and Air Quality for Reducing Transmission of COVID-19 Good ventilation and indoor air quality are important in reducing airborne exposure to viruses, including SARS-CoV-2 that causes COVID-19, as well as other disease vectors, chemicals, and odors. However, buildings vary in design, age, Heating Ventilation and Air Conditioning (HVAC Mechanical ventilation weaning protocols in critically ill adults and children . Date 2020-03-24. Author. Allen, Claire. Metadata Show full item record. Abstract. What is this? Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive. After a review of the best available scientific evidence and federal and state guidelines, we recommend focusing efforts for preventing the spread of COVID-19 on key public health practices, including social distancing, face coverings, hand hygiene, isolation and quarantine protocols, and proper cleaning and disinfection of surfaces.When all faculty, staff and students adhere to these. Questions regarding ventilation of COVID-19 patients. In an emergency, could it be possible to connect several people to one ventilator? Using a Y-connector if necessary? Hamilton Medical does not recommend the use of one mechanical ventilator for more than one patient
Figure 1: Summary of Critical Care Protocol for COVID-19 It is expected that somewhere between 5-15% of hospitalized patients with COVID-19 will develop In the particular case of COVID-19, mechanical ventilation results in the patient breathing in a closed, filtered circuit that may reduce the risk of viral transmission Mechanical Ventilation Mechanical ventilation is to be implemented early in patients with COVID-19 pneumonia in respiratory failure Positive pressure ventilation (PPV) Most common mode is Volume Control •Delivers a set volume with each breath •Airway pressures will vary with respiratory mechanics and must be monitored to avoi Before COVID-19 began its steady march across the nation, New York's supply of 11,000 ventilators—mechanical devices that pump oxygen-rich air into the lungs—seemed sufficient to meet the needs of patients in intensive care units requiring breathing assistance. Gov INTRODUCTION — Coronavirus disease 2019 (COVID-19) can progress in a subset of patients to acute respiratory distress syndrome (ARDS), which often requires intubation and mechanical ventilation.. This topic discusses the management and prognosis of the intubated patient with COVID-19. Clinical features and respiratory care of the non-intubated patient with COVID-19 and management of the. Procedure Manual: COVID-19 Resources. This resource guides you through procedures unique to the adult progressive and critical care environment, including those performed by advanced practice nurses, in a step-by-step format. You can find the complete AACN Procedure Manual in the AACN Store
Protocol Title: REACT COVID-19: Real world Evidence for Anti-Cytokine Therapy in COVID-19, an international, multi-center, observational study. ICU transfer, initiation of mechanical ventilation, or initiation of ECMO at 14-days from initiation of anti-cytokine therapy. Pooled data from Cohort 1 and 2 will be used for analysis of the. Mechanical ventilation weaning protocols in critically ill adults and children. What is this? Some patients with COVID-19 will develop respiratory failure and need help with their breathing. This might be provided by mechanical ventilation (MV) in an intensive care unit (ICU). Various methods are used to help wean patients off MV Ventilation is not a substitute for other non-clinical interventions, such as environmental cleaning, physical distancing, face coverings or maintaining good hand and respiratory hygiene, but should be considered as part of a range of mitigation measures. Summary. COVID-19 is spread through the air in droplets and aerosols (finer particles/ drops COVID-19 WORKPLACE PROTOCOLS . MAY, 2020 2 Environmental Health Interim Guidelines and Procedures for the Reopening of Public Facilities /Spaces for COVID-19 Introduction A Public Health Emergency of International Concern (PHEIC) was declared for the B. Install and Maintain Effective Ventilation Systems. In creating and maintaining a. Options for ventilating covid-19 patients have expanded since the first wave of the pandemic, but doctors are unsure of the best management pathway because evidence is lacking, reports Ingrid Torjesen During the first wave of the covid-19 pandemic, almost three quarters of patients who were admitted to critical care received invasive ventilation, and one in two received it within 24 hours of.
Ventilation should be considered alongside other control measures to reduce the risk of COVID-19 transmission within your workplace or public indoor space. It is important to identify and deal. Before COVID, there were several hundred thousand cases of ARDS in the United States each year, most of which required mechanical ventilation. But in the past year there have been 21 million COVID-19 patients at risk, said Englert, a physician who treats ICU patients
Positioning, not ventilation could be key to COVID-19 treatment. From the beginning, it has been one of the tell-tale signs of COVID-19: extremely low blood oxygen saturation levels COVID-19 admitted to an intensive care unit (ICU) in Wuhan, China. 29 (56%) of 52 patients were given non-invasive ventilation at ICU admission, of whom 22 (76%) required further orotracheal intubation and invasive mechanical ventilation. The ICU mortality rate among those who required non-invasive ventilation was 23 (79%
Where mechanical ventilation is available, it is the preferred means of respiratory support in COVID-19 patients. In the presence of bilateral infiltrates and hypoxemia, mechanical ventilation with low tidal volumes may be less injurious than continued vigorous spontaneous breathing with or without non-invasive support, but thi Coronavirus disease (COVID-19): Ventilation and air conditioning in public spaces and buildings. For advice on ventilation, please see the ventilation roadmap. This roadmap replaces the July 2020 WHO Q&A on the same topic Patients were given symptomatic treatment for COVID-19, in addition to azithromycin 500 mg/day for 7 days, Oxygen therapy and non-invasive or mechanical ventilation when needed
Announcements. COVID-19 VENTILATION GUIDANCE; COVID-19 VENTILATION GUIDANCE. As the University prepares for a phased return to campus, Facilities is sharing guidance with partners in the schools, departments and units about plans for keeping buildings properly ventilated to optimize the safety of our community The use of mechanical ventilation saves lives—and not just for COVID-19 patients who develop severe respiratory problems. But at the same time, the ventilation pressure puts immense stress on.
We characterized COVID-19 respiratory failure in 66 patients managed with mechanical ventilation and established ARDS protocols. Almost all of the patients presented with dyspnea and were intubated on the day of hospital presentation. Upon initiation of mechanical ventilation, the patients had a median Pa O 2:FIO Roche has reported that its Actemra/RoActemra (tocilizumab) reduced the need for mechanical ventilation in hospitalised Covid-19 patients with associated pneumonia in the Phase III EMPACTA clinical trial. The trial met the primary endpoint, with patients on Actemra plus standard of care found to be 44% less likely to progress to mechanical. The 10-day group also had 9 patients receiving mechanical ventilation (versus 4) and a higher proportion of men (68% versus 60%), who tend to have worse COVID-19 outcomes. Fourteen days later, 65% of patients in the 5-day group had a clinical improvement of 2 or more points on a 7-point ordinal scale, compared with 54% in the 10-day group
The Public Health Agency of Canada (PHAC) has developed this guide to inform Canadians about how indoor ventilation, in combination with other recommended public health measures, can reduce the spread of COVID-19. This guide also provides practical tips on how to improve indoor air, ventilation and filtration to help reduce the spread of COVID-19 Ventilator Remote Controller Project. In conversations with physicians and nurses caring for COVID-19 patients globally, it has become evident that they are understaffed and struggling to keep up with such a large population of Acute Respiratory Distress Syndrome (ARDS) patients. The majority of current mechanical ventilation units available to. Deaths usually result from multisystem organ failure rather than lung failure alone. 5.3 ZYESAMI Experimental Therapy in COVID-19 Under this protocol, patients with Critical COVID-19 will be treated with ZYESAMI (Aviptadil) with the aim to support pulmonary alveolar function, combat the cytokine-induced inflammation, improve blood oxygenation. Some studies show that obese people infected with COVID-19 have a high frequency of admission to the intensive care unit and the need of using invasive mechanical ventilation in addition to the association between the highest mortality rates and body mass ratio [10, 11]. Thus, obese patients tend to have a more severe course of COVID-19
LLNL develops 'stopgap' ventilator for COVID-19 use. Jeremy Thomas, email@example.com, 925-422-5539. While hospitals across the U.S. faced a possible shortage of mechanical ventilators due to COVID-19, a self-assembled skunk works team at Lawrence Livermore National Laboratory (LLNL) worked tirelessly to prototype a simple ventilator. Single dose for procedure, mechanical ventilation or hypothermia : Rocuronium : 0.6-1.2 mg/kg (round to nearest 10 mg) Continuous infusion for hypothermia or mechanical ventilation. Rocuronium: 0.5-0.7 mg/kg/hr: Continuous infusion for severe ARDS. Cisatracurium : 15 mg bolus followed by 37.5 mg/hr x 48 hours then stop or convert to rocuronium. Their studies have led to the creation of safety protocols for singing and playing musical instruments to help prevent the spread of COVID-19. In March 2020 musicians around the world were stunned to learn that gathering to play wind instruments or singing may be activities that could result in significant spread of the COVID-19 virus.