COVID-19 Critical Illness: A Data-Driven Review

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges in critical care medicine, including extreme demand for intensive care unit (ICU) resources and rapidly evolving understanding of a novel disease. Up to one-third of hospitalized patients with COVID-19 experience critical illness. The most common form of organ failure in COVID-19 critical illness is acute hypoxemic respiratory failure, which clinically presents as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Noninvasive respiratory support modalities are being used with increasing frequency given their potential to reduce the need for intubation. Determining optimal patient selection for and timing of intubation remains a challenge. Management of mechanically ventilated patients with COVID-19 largely mirrors that of non-COVID-19 ARDS. Organ failure is common and portends a poor prognosis. Mortality rates have improved over the course of the pandemic, likely owing to increasing disease familiarity, data-driven pharmacologics, and improved adherence to evidence-based critical care. Expected final online publication date for the Annual Review of Medicine, Volume 73 is January 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.

Differential Functional Responses of Neutrophil Subsets in Severe COVID-19 Patients

“…Neutrophil recruitment and activation, leading to the release of reactive oxygen species (ROS), degranulation, and neutrophil extracellular trap (NET) formation, are critical components of ARDS pathophysiology ( 1 , 2 ). Among patients hospitalized with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced coronavirus disease 2019 (COVID-19), approximately 1/3 develop ARDS, making COVID-19 the current leading cause of ARDS ( 3 – 6 ). Despite some potential differences in pathophysiology, accumulating evidence indicates that neutrophils also play a critical role in the development of COVID-19 ARDS.…”

Inflammasome activation in infected macrophages drives COVID-19 pathology

“…Thus, inflammasomes oppose host infection by SARS-CoV-2 through the production of inflammatory cytokines and suicide by pyroptosis to prevent a productive viral cycle.Acute SARS-CoV-2 infection resolves in most patients but becomes chronic and sometimes deadly in about 10-20% of patients [1][2][3][4][5][6][7][14][15][16]20,[24][25][26][27] . Two hallmarks of severe COVID-19 are a sustained IFN response and viral RNA persisting for months [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]20,[24][25][26][27][28] . This chronicity is recapitulated in SARS-CoV-2-infected MISTRG6-hACE2 humanized mice 19 .…”

“…Acute SARS-CoV-2 infection resolves in most patients but becomes chronic and sometimes deadly in about 10-20% of patients [1][2][3][4][5][6][7][14][15][16]20,[24][25][26][27] . Two hallmarks of severe COVID-19 are a sustained IFN response and viral RNA persisting for months [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17]20,[24][25][26][27][28] . This chronicity is recapitulated in SARS-CoV-2-infected MISTRG6-hACE2 humanized mice 19 .…”

Emergency hospitalization caused by non-COVID-19 respiratory diseases before and during the COVID-19 pandemic: A retrospective observational cohort study

“…In consideration of the emergency visits and hospitalizations might be affected by atmosphere air quality and climate change, we collected data of air quality in the district where the 10.3389/fmed.2022.929353 hospital was located from the official online monitoring and analysis platform in China. 1 The key related parameters of air quality and weather included air quality index, air quality grade, particulate matter 2.5 (PM2.5), PM10, PM 25, sulfur dioxide, carbon monoxide, nitrogen dioxide, ozone, and air temperature. According to the calendar year, spring, summer, fall, and winter started on February 4th, May 6th, August 8th, and November 8th in 2019 and February 4th, May 5th, August 7th, and November 7th in 2020, respectively.…”

“…Over the past 2 years, the coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented challenges in the worldwide healthcare system and critical care medicine ( 1 ). At present, there is still no sign of the pandemic receding.…”