Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations

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.

Figure 1

Initial approach to critically ill patients with suspected COVID-19 COVID-19=coronavirus disease 2019. ICU=intensive care unit. PPE=personal protective equipment.

Figure 2

Clinical management of critically ill patients with COVID-19 ARDS=acute respiratory distress syndrome. COVID-19=coronavirus disease 2019. ECMO=extracorporeal membrane oxygenation. HFNC=high-flow nasal cannula. NIV=non-invasive ventilation. PaO₂/FiO₂=partial pressure of arterial oxygen to fraction of inspired oxygen. PPE=personal protective equipment.