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:
- Elderly patients (age>60 years)
- 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.
- Patients have comorbidities like diabetes and cardiac disease.
- 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:
- Conservative intravenous fluid strategies
- Empirical early antibiotics for possible bacterial pneumonia
- Consideration for early invasive ventilation
- Lung-protective ventilation strategies
- Periodic prone positioning during mechanical ventilation
- 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