JAMA Covid Guidelines

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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

Facility planning

  • 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

Specific considerations

  • 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.