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The blistering pace of publications regarding COVID-19 makes it challenging for clinicians to synthesize best practices. This review article provides an expert consensus and an evidence-based approach to the management of COVID-19 patients. Highlights include a discussion on use of noninvasive ventilation strategies and making the decision to intubate, changes to usual care, and therapeutics.
Much of the management of COVID-19 remains centered on our existing ARDS protocols, and consensus recommends dexamethasone and remdesivir for all hospitalized patients. Updates will continue to evolve as this pandemic rages on.
– Kolene E. Bailey, MD
This abstract is available on the publisher's site.
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.