Caring for critically ill patients with COVID-19 is based on the usual management of viral pneumonia with respiratory failure with additional precautions to reduce risk of transmission.
Usual critical care
Many patients with severe COVID-19 develop acute respiratory distress syndrome (ARDS). Evidence-based guidelines for ARDS in the context of COVID-19 include treatments such as
- Lung-protective ventilation strategies
- Conservative intravenous fluid strategies
- Periodic prone positioning during mechanical ventilation
- Empirical early antibiotics for possible bacterial pneumonia
- Consideration for early invasive ventilation
- Consideration of ECMO
Modifications to usual critical care
- Admission of patients with suspected disease to private rooms when possible
- Use of medical face masks for symptomatic patients during assessment and transfer
- Maintain distancing of at least 2 m between patients
- Caution when using high-flow nasal oxygen or noninvasive ventilation due to risk of dispersion of aerosolized virus in the health care environment with poorly fitting masks
- Clinicians involved with aerosol-generating procedures should use additional airborne precautions including N95 respirators and eye protection
- Ensure staff have updated training in infection prevention and control including personal protective equipment
- Planning at local and regional levels for a potential surge in the need for critical care resources
- Antiviral or immunomodulatory therapies are not yet proven effective for treatment of COVID-19.
- Patients should be asked to participate in clinical trials of supportive or targeted therapies.