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Review
. 2020 Dec;115(Suppl 3):111-114.
doi: 10.1007/s00063-020-00689-w.

German recommendations for critically ill patients with COVID‑19

Stefan Kluge  1   2   3   4 , Uwe Janssens  5   6   7 , Tobias Welte  8   7 , Steffen Weber-Carstens  9   7 , Gernot Marx  6   9   7 , Christian Karagiannidis  5   6   7
Affiliations
Review

German recommendations for critically ill patients with COVID‑19

Stefan Kluge et al. Med Klin Intensivmed Notfmed. 2020 Dec.

Abstract
in English, German

Since December 2019, a novel coronavirus (severe acute respiratory syndrome-coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The majority of patients presents with mild symptoms of coronavirus disease 2019 (COVID-19). However, about 5% become critically ill and require intensive care treatment. Acute hypoxemic failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to ICU admission. At that point, bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS). To date there is no specific treatment available-the main goal of supportive therapy is to ascertain adequate oxygenation. Early intubation and repeated prone positioning are key elements in treating hypoxemic COVID-19 patients. Strict adherence to basic infection control measures (including hand hygiene) and use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be avoided where possible and carried out with utmost precaution.

Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV‑2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Maß.Die Mehrheit der Patienten zeigt lediglich milde Symptome der sogenannten Coronavirus Disease 2019 (COVID-19). Dennoch benötigen etwa 5 % eine intensivmedizinische Behandlung. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (>30/min) führt in der Regel zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate in der Bildgebung und im Verlauf entwickeln viele Patienten ein Acute Respiratory Distress Syndrome (ARDS).Bisher gibt es noch keine zugelassene spezifische Therapieoption. Das Hauptziel der supportiven Therapie ist, eine ausreichende Oxygenierung sicherzustellen. Die frühe Intubation und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von hypoxämischen COVID-19 Patienten.Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung ist im Umgang mit den Patienten unabdingbar. Prozeduren, die zur Aerosolbildung führen könnten, sollten, soweit möglich, vermieden, und, falls nötig, mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.

Keywords: ARDS; Acute respiratory failure; COVID-19; Coronavirus; High-flow nasal cannula.

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Conflict of interest statement

S. Kluge received research support by Ambu, E.T.View Ltd, Fisher & Paykel, Pfizer and Xenios. He also received lecture honorarium from ArjoHuntleigh, Astellas, Astra, Basilea, Bard, Baxter, Biotest, CSL Behring, Cytosorbents, Fresenius, Gilead, MSD, Orion, Pfizer, Philips, Sedana, Sorin, Xenios and Zoll. He received consultant honorarium from AMOMED, Astellas, Baxter, Bayer, Fresenius, Gilead, MSD, Pfizer and Xenios. U. Janssens has declared no conflict of interest. T. Welte received lecture honorarium and travel grants from Gilead. S. Weber-Carstens works in a research cooperation with Dräger. G. Marx received consultant honorarium and research support by Biotest, B.Braun und Adrenomed. C. Karagiannidis received consultant honoraria from Bayer und Xenios.

References

    1. Xie J, Tong Z, Guan X, Du B, Qiu H, Slutsky AS. Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Med. 2020 doi: 10.1007/s00134-020-05979-7. - DOI - PMC - PubMed
    1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019. outbreak in China: summary of a report of: JAMA; 2020. - PubMed
    1. Chung M, Bernheim A, Mei X, Zhang N, Huang M, Zeng X, et al. CT imaging features of 2019 novel coronavirus (2019-ncoV) Radiology. 2020 doi: 10.1148/radiol.2020200230. - DOI - PMC - PubMed
    1. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV‑2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020;2(0):30079–30075. doi: 10.1016/S2213-2600. - DOI - PMC - PubMed
    1. Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al. Clinical characteristics of coronavirus disease 2019in China. N. Engl J Med. 2020 doi: 10.1056/NEJMoa2002032. - DOI - PMC - PubMed