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Care for Critically Ill Patients with COVID-19

Objective: To manage critically ill patients with coronavirus disease of 2019 (COVID-19)

Initial reports suggest that COVID-19 is associated with severe disease that requires intensive care in approximately 5% of proven infections. Caring for critically ill patients with COVID-19 is similar to the management of viral pneumonia with respiratory failure with additional precautions to reduce risk of transmission.

Factors associated with requiring intensive care:

  1. Elderly patients (age>60 years)
  2. The median duration between onset of symptoms and intensive care unit admission has been 9 to 10 days that suggests a gradual deterioration in the majority of cases.
  3. Patients have comorbidities like diabetes and cardiac disease.
  4. Many patients with severe COVID-19 develop acute respiratory distress syndrome (ARDS). Evidence-based guidelines for ARDS in the context of COVID-19 include treatments such as:
    1. Conservative intravenous fluid strategies
    2. Empirical early antibiotics for possible bacterial pneumonia
    3. Consideration for early invasive ventilation
    4. Lung-protective ventilation strategies
    5. Periodic prone positioning during mechanical ventilation
    6. Consideration of extracorporeal membrane oxygenation

Reference: Murthy S, Gomersall CD, Fowler RA. Care for Critically Ill Patients With COVID-19. JAMA. 2020 Mar 11. doi: 10.1001/jama.2020.3633