Management of Critically Ill Adults With COVID-19

Abstract

This JAMA Clinical Guidelines Synopsis summarizes the 2020 Surviving Sepsis Campaign guidelines on the treatment of critically ill adults with coronavirus disease 2019 (COVID-19).

Helmet CPAP to Treat Acute Hypoxemic Respiratory Failure in Patients with COVID-19: A Management Strategy Proposal

“…The authors recommend the use of high flow oxygen therapy and non-invasive positive pressure ventilation if high flow oxygen is unavailable or ineffective in COVID-19 patients with acute respiratory failure [31]. Surprisingly, the application of CPAP is not mentioned [31]. Due to the pathophysiology of the acute respiratory failure in COVID-19 patients, we believe that an approach based on non-invasive ventilation, unless hypercapnia is present, could be avoided.…”

“…During the writing of the present manuscript, the Surviving Sepsis Campaign (SSC) has released new guidelines for the management of critically ill adults with COVID-19 [31]. The authors recommend the use of high flow oxygen therapy and non-invasive positive pressure ventilation if high flow oxygen is unavailable or ineffective in COVID-19 patients with acute respiratory failure [31].…”

“…Due to the pathophysiology of the acute respiratory failure in COVID-19 patients, we believe that an approach based on non-invasive ventilation, unless hypercapnia is present, could be avoided. Considering also the poor availability During the writing of the present manuscript, the Surviving Sepsis Campaign (SSC) has released new guidelines for the management of critically ill adults with COVID-19 [31]. The authors recommend the use of high flow oxygen therapy and non-invasive positive pressure ventilation if high flow oxygen is unavailable or ineffective in COVID-19 patients with acute respiratory failure [31].…”

Compassionate Use of Remdesivir for Patients with Severe Covid-19

“…6,7 In the absence of a proven effective therapy, current management consists of supportive care, including invasive and noninvasive oxygen support and treatment with antibiotics. 8,9 In addition, many patients have received off-label or compassionate-use therapies, including antiretrovirals, antiparasitic agents, antiinflammatory compounds, and convalescent plasma. [10][11][12][13] Remdesivir is a prodrug of a nucleotide analogue that is intracellularly metabolized to an analogue of adenosine triphosphate that inhibits viral RNA polymerases.…”

Therapeutic strategies for critically ill patients with COVID-19

“…Therefore, it is necessary to assess fluid responsiveness and to evaluate ventricular function during fluid resuscitation. Conservative fluid administration while maintaining adequate mean arterial pressure and organ perfusion with the appropriate use of diuretics and vasopressors is of importance [99].…”