COVID-19-related Organ Dysfunction and Management Strategies on the Intensive Care Unit: a Narrative Review

Overview

Journal Br J Anaesth

Publisher Elsevier

Specialty Anesthesiology

Date 2020 Sep 29

PMID 32988604

Citations 26

Authors

Peter B Sherren

Marlies Ostermann

Sangita Agarwal

Christopher I S Meadows

Nicholas Ioannou

Luigi Camporota

Affiliations

Soon will be listed here.

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has resulted in a significant surge of critically ill patients and an unprecedented demand on intensive care services. The rapidly evolving understanding of pathogenesis, limited disease specific evidence, and demand-resource imbalances have posed significant challenges for intensive care clinicians. COVID-19 is a complex multisystem inflammatory vasculopathy with a significant mortality implication for those admitted to intensive care. Institutional strategic preparation and meticulous intensive care support are essential to maximising outcomes during the pandemic. The significant mortality variation observed between institutions and internationally, despite a single aetiology and uniform presentation, highlights the potential influence of management strategies on outcome. Given that optimal organ support and adjunctive therapies for COVID-19 have not yet been well defined by trial-based outcomes, strategies are predicated on existing literature and experiential learning. This review outlines the relevant pathophysiology and management strategies for critically ill patients with COVID-19, and shares some of the collective learning accumulated in a high volume severe respiratory failure centre in London.

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References

Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C . Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med. 2020; 8(4):420-422. PMC: 7164771. DOI: 10.1016/S2213-2600(20)30076-X. View

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A . Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA. 2020; 323(16):1574-1581. PMC: 7136855. DOI: 10.1001/jama.2020.5394. View

Klok F, Kruip M, van der Meer N, Arbous M, Gommers D, Kant K . Incidence of thrombotic complications in critically ill ICU patients with COVID-19. Thromb Res. 2020; 191:145-147. PMC: 7146714. DOI: 10.1016/j.thromres.2020.04.013. View

Inciardi R, Lupi L, Zaccone G, Italia L, Raffo M, Tomasoni D . Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(7):819-824. PMC: 7364333. DOI: 10.1001/jamacardio.2020.1096. View

Durvasula R, Wellington T, McNamara E, Watnick S . COVID-19 and Kidney Failure in the Acute Care Setting: Our Experience From Seattle. Am J Kidney Dis. 2020; 76(1):4-6. PMC: 7141473. DOI: 10.1053/j.ajkd.2020.04.001. View

Wang W, Liu X, Wu S, Chen S, Li Y, Nong L . Definition and Risks of Cytokine Release Syndrome in 11 Critically Ill COVID-19 Patients With Pneumonia: Analysis of Disease Characteristics. J Infect Dis. 2020; 222(9):1444-1451. PMC: 7337810. DOI: 10.1093/infdis/jiaa387. View

Rodriguez A, Ferri C, Martin-Loeches I, Diaz E, Masclans J, Gordo F . Risk Factors for Noninvasive Ventilation Failure in Critically Ill Subjects With Confirmed Influenza Infection. Respir Care. 2017; 62(10):1307-1315. DOI: 10.4187/respcare.05481. View

Li Y, Bai W, Hashikawa T . The neuroinvasive potential of SARS-CoV2 may play a role in the respiratory failure of COVID-19 patients. J Med Virol. 2020; 92(6):552-555. PMC: 7228394. DOI: 10.1002/jmv.25728. View

Hall A, Busse L, Ostermann M . Angiotensin in Critical Care. Crit Care. 2018; 22(1):69. PMC: 5861652. DOI: 10.1186/s13054-018-1995-z. View

10.

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

11.

Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y . Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020; 382(13):1199-1207. PMC: 7121484. DOI: 10.1056/NEJMoa2001316. View

12.

Peleg Y, Kudose S, DAgati V, Siddall E, Ahmad S, Nickolas T . Acute Kidney Injury Due to Collapsing Glomerulopathy Following COVID-19 Infection. Kidney Int Rep. 2020; 5(6):940-945. PMC: 7186120. DOI: 10.1016/j.ekir.2020.04.017. View

13.

Hoeper M, Granton J . Intensive care unit management of patients with severe pulmonary hypertension and right heart failure. Am J Respir Crit Care Med. 2011; 184(10):1114-24. DOI: 10.1164/rccm.201104-0662CI. View

14.

Kwong J, Schwartz K, Campitelli M, Chung H, Crowcroft N, Karnauchow T . Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med. 2018; 378(4):345-353. DOI: 10.1056/NEJMoa1702090. View

15.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J . Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020; 323(11):1061-1069. PMC: 7042881. DOI: 10.1001/jama.2020.1585. View

16.

Russotto V, Bellani G, Foti G . Respiratory mechanics in patients with acute respiratory distress syndrome. Ann Transl Med. 2018; 6(19):382. PMC: 6212350. DOI: 10.21037/atm.2018.08.32. View

17.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T . Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020; 5(7):811-818. PMC: 7101506. DOI: 10.1001/jamacardio.2020.1017. View

18.

Panka B, de Grooth H, Spoelstra-de Man A, Looney M, Tuinman P . Prevention or Treatment of Ards With Aspirin: A Review of Preclinical Models and Meta-Analysis of Clinical Studies. Shock. 2016; 47(1):13-21. PMC: 5175412. DOI: 10.1097/SHK.0000000000000745. View

19.

Guan W, Ni Z, Hu Y, Liang W, Ou C, He J . Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med. 2020; 382(18):1708-1720. PMC: 7092819. DOI: 10.1056/NEJMoa2002032. View

20.

Poyiadji N, Shahin G, Noujaim D, Stone M, Patel S, Griffith B . COVID-19-associated Acute Hemorrhagic Necrotizing Encephalopathy: Imaging Features. Radiology. 2020; 296(2):E119-E120. PMC: 7233386. DOI: 10.1148/radiol.2020201187. View