Evidence-Based Management of the Critically Ill Adult With SARS-CoV-2 Infection. (January 2021)

• Record Type: Journal Article
• Authors: Chivukula, Raghu R.; Maley, Jason H.; Dudzinski, David M.; Hibbert, Kathryn; Hardin, C. Corey
• Is Part Of: Journal of intensive care medicine. Volume 36:Number 1(2021)
• Page Start: 18
• Page End: 41
• Publication Date: 2021-01
• Subjects: coronavirus -- SARS-CoV-2 -- COVID-19 -- pandemic -- critical care -- acute respiratory failure -- acute respiratory distress syndrome (ARDS) -- hypoxemia; Critical care medicine -- Periodicals; Critical Care -- Periodicals; Soins intensifs -- Périodiques; Soins intensifs; Périodique électronique (Descripteur de forme); Ressource Internet (Descripteur de forme); 616.02805
• DOI: 10.1177/0885066620969132
• Languages: English
• ISSNs: 0885-0666

Abstract

Human infection by the novel viral pathogen SARS-CoV-2 results in a clinical syndrome termed Coronavirus Disease 2019 (COVID-19). Although the majority of COVID-19 cases are self-limiting, a substantial minority of patients develop disease severe enough to require intensive care. Features of critical illness associated with COVID-19 include hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), shock, and multiple organ dysfunction syndrome (MODS). In most (but not all) respects critically ill patients with COVID-19 resemble critically ill patients with ARDS due to other causes and are optimally managed with standard, evidence-based critical care protocols. However, there is naturally an intense interest in developing specific therapies for severe COVID-19. Here we synthesize the rapidly expanding literature around the pathophysiology, clinical presentation, and management of COVID-19 with a focus on those points most relevant for intensivists tasked with caring for these patients. We specifically highlight evidence-based approaches that we believe should guide the identification, triage, respiratory support, and general ICU care of critically ill patients infected with SARS-CoV-2. In addition, in light of the pressing need and growing enthusiasm for targeted COVID-19 therapies, we review the biological basis, plausibility, and clinical evidence underlying these novel treatment approaches.