Intensive Care Management of Coronavirus Disease 2019 (COVID-19): Challenges and Recommendations

Overview

Journal Lancet Respir Med

Publisher Elsevier

Specialty Pulmonary Medicine

Date 2020 Apr 10

PMID 32272080

Citations 773

Authors

Jason Phua

Li Weng

Lowell Ling

Moritoki Egi

Chae-Man Lim

Jigeeshu Vasishtha Divatia

Babu Raja Shrestha

Yaseen M Arabi

Jensen Ng

Charles D Gomersall

Masaji Nishimura

Younsuck Koh

Bin Du

Affiliations

Soon will be listed here.

Abstract

As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.

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References

Mair-Jenkins J, Saavedra-Campos M, Baillie J, Cleary P, Khaw F, Lim W . The effectiveness of convalescent plasma and hyperimmune immunoglobulin for the treatment of severe acute respiratory infections of viral etiology: a systematic review and exploratory meta-analysis. J Infect Dis. 2014; 211(1):80-90. PMC: 4264590. DOI: 10.1093/infdis/jiu396. View

Ranieri V, Pettila V, Karvonen M, Jalkanen J, Nightingale P, Brealey D . Effect of Intravenous Interferon β-1a on Death and Days Free From Mechanical Ventilation Among Patients With Moderate to Severe Acute Respiratory Distress Syndrome: A Randomized Clinical Trial. JAMA. 2020; 323(8):725-733. DOI: 10.1001/jama.2019.22525. View

Pang J, Wang M, Ang I, Tan S, Lewis R, Chen J . Potential Rapid Diagnostics, Vaccine and Therapeutics for 2019 Novel Coronavirus (2019-nCoV): A Systematic Review. J Clin Med. 2020; 9(3). PMC: 7141113. DOI: 10.3390/jcm9030623. View

Wu Z, McGoogan J . Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020; 323(13):1239-1242. DOI: 10.1001/jama.2020.2648. View

Rosenbaum L . Facing Covid-19 in Italy - Ethics, Logistics, and Therapeutics on the Epidemic's Front Line. N Engl J Med. 2020; 382(20):1873-1875. DOI: 10.1056/NEJMp2005492. View

Rhodes A, Ferdinande P, Flaatten H, Guidet B, Metnitz P, Moreno R . The variability of critical care bed numbers in Europe. Intensive Care Med. 2012; 38(10):1647-53. DOI: 10.1007/s00134-012-2627-8. View

Beigel J, Voell J, Kumar P, Raviprakash K, Wu H, Jiao J . Safety and tolerability of a novel, polyclonal human anti-MERS coronavirus antibody produced from transchromosomic cattle: a phase 1 randomised, double-blind, single-dose-escalation study. Lancet Infect Dis. 2018; 18(4):410-418. PMC: 5871563. DOI: 10.1016/S1473-3099(18)30002-1. View

Luke T, Wu H, Zhao J, Channappanavar R, Coleman C, Jiao J . Human polyclonal immunoglobulin G from transchromosomic bovines inhibits MERS-CoV in vivo. Sci Transl Med. 2016; 8(326):326ra21. DOI: 10.1126/scitranslmed.aaf1061. View

Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G . A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med. 2020; 382(19):1787-1799. PMC: 7121492. DOI: 10.1056/NEJMoa2001282. View

10.

Lippi G, Lavie C, Sanchis-Gomar F . Cardiac troponin I in patients with coronavirus disease 2019 (COVID-19): Evidence from a meta-analysis. Prog Cardiovasc Dis. 2020; 63(3):390-391. PMC: 7127395. DOI: 10.1016/j.pcad.2020.03.001. View

11.

Adams J, Walls R . Supporting the Health Care Workforce During the COVID-19 Global Epidemic. JAMA. 2020; 323(15):1439-1440. DOI: 10.1001/jama.2020.3972. View

12.

Remuzzi A, Remuzzi G . COVID-19 and Italy: what next?. Lancet. 2020; 395(10231):1225-1228. PMC: 7102589. DOI: 10.1016/S0140-6736(20)30627-9. View

13.

Alhazzani W, Moller M, Arabi Y, Loeb M, Gong M, Fan E . Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020; 46(5):854-887. PMC: 7101866. DOI: 10.1007/s00134-020-06022-5. View

14.

Dong L, Hu S, Gao J . Discovering drugs to treat coronavirus disease 2019 (COVID-19). Drug Discov Ther. 2020; 14(1):58-60. DOI: 10.5582/ddt.2020.01012. View

15.

Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky A . Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020; 46(5):837-840. PMC: 7080165. DOI: 10.1007/s00134-020-05979-7. View

16.

Wai J, Gomersall C . A controlled crossover human volunteer study of the in vivo filtration efficacy of a high-efficiency particulate air-filtering oxygen mask. Am J Infect Control. 2011; 39(9):782-4. DOI: 10.1016/j.ajic.2010.12.015. View

17.

Arabi Y, Asiri A, Assiri A, Jokhdar H, Alothman A, Balkhy H . Treatment of Middle East respiratory syndrome with a combination of lopinavir/ritonavir and interferon-β1b (MIRACLE trial): statistical analysis plan for a recursive two-stage group sequential randomized controlled trial. Trials. 2020; 21(1):8. PMC: 6942374. DOI: 10.1186/s13063-019-3846-x. View

18.

Qiu H, Tong Z, Ma P, Hu M, Peng Z, Wu W . Intensive care during the coronavirus epidemic. Intensive Care Med. 2020; 46(4):576-578. PMC: 7080064. DOI: 10.1007/s00134-020-05966-y. View

19.

Song Y, Yao C, Yao Y, Han H, Zhao X, Yu K . XueBiJing Injection Versus Placebo for Critically Ill Patients With Severe Community-Acquired Pneumonia: A Randomized Controlled Trial. Crit Care Med. 2019; 47(9):e735-e743. PMC: 6727951. DOI: 10.1097/CCM.0000000000003842. View

20.

Arabi Y, Phua J, Koh Y, Du B, Faruq M, Nishimura M . Structure, Organization, and Delivery of Critical Care in Asian ICUs. Crit Care Med. 2016; 44(10):e940-8. DOI: 10.1097/CCM.0000000000001854. View