Summary In December 2019, a cluster of atypical pneumonia cases were reported in Wuhan, China, and a novel coronavirus elucidated as the aetiologic agent. Although most initial cases occurred in China, the disease, termed coronavirus disease 2019, has become a pandemic and continues to spread rapidly with human‐to‐human transmission in many countries. This is the third novel coronavirus outbreak in the last two decades and presents an ensuing healthcare resource burden that threatens to overwhelm available healthcare resources. A study of the initial Chinese response has shown that there is a significant positive association between coronavirus disease 2019 mortality and healthcare resource burden. Based on the Chinese experience, some 19% of coronavirus disease 2019 cases develop severe or critical disease. This results in a need for adequate preparation and mobilisation of critical care resources to anticipate and adapt to a surge in coronavirus disease 2019 case‐load in order to mitigate morbidity and mortality. In this article, we discuss some of the peri‐operative and critical care resource planning considerations and management strategies employed in a tertiary academic medical centre in Singapore in response to the coronavirus disease 2019 outbreak.

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With the exponential surge in patients with coronavirus disease 2019 (COVID-19) worldwide, the resources needed to provide continuous kidney replacement therapy (CKRT) for patients with acute kidney injury or kidney failure may be threatened. This article summarizes subsisting strategies that can be implemented immediately. Pre-emptive weekly multicenter projections of CKRT demand based on evolving COVID-19 epidemiology and routine workload should be made. Corresponding consumables should be quantified and acquired, with diversification of sources from multiple vendors. Supply procurement should be stepped up accordingly so that a several-week stock is amassed, with administrative oversight to prevent disproportionate hoarding by institutions. Consumption of CKRT resources can be made more efficient by optimizing circuit anticoagulation to preserve filters, extending use of each vascular access, lowering blood flows to reduce citrate consumption, moderating the CKRT intensity to conserve fluids, or running accelerated KRT at higher clearance to treat more patients per machine. If logistically feasible, earlier transition to intermittent hemodialysis with online-generated dialysate, or urgent peritoneal dialysis in selected patients, may help reduce CKRT dependency. These measures, coupled to multicenter collaboration and a corresponding increase in trained medical and nursing staffing levels, may avoid downstream rationing of care and save lives during the peak of the pandemic. Complete author and article information provided before references.

of renal dysfunction has been described in COVID-19 patients. 9 As a result, serum potassium may be increased, putting them at a higher risk of developing critical hyperkalaemia after receiving succinylcholine. Our patient, despite having renal dysfunction, had a potassium of 4.0 mM days before the intubation, and her highest registered potassium value was 6.4 mM, below the 6.5 mM hyperkalaemia threshold defined as the critical value for cardiac arrhythmia. 10 It is highly likely that we missed the peak potassium concentration as the epinephrine administered may have driven the potassium intracellularly. Despite a long ICU stay, our patient had not been diagnosed with critical illness myopathy.The ongoing COVID-19 pandemic has led to unprecedented shortages of anaesthetic drugs in many countries. This led the Royal College of Anaesthetists to issue guidance on alternative drugs for COVID-19 patients, which included the use of succinylcholine rather than rocuronium for tracheal intubation. In our mind, succinylcholine was the primary cause of cardiac arrest in this patient. We recommend use of rocuronium as the first-choice neuromuscular blocking agent for RSI in critically ill COVID-19 patients.