Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

You Shang¹, Chun Pan², Xianghong Yang³, Ming Zhong⁴, Xiuling Shang⁵, Zhixiong Wu⁶, Zhui Yu⁷, Wei Zhang⁸, Qiang Zhong⁹, Xia Zheng¹⁰, Ling Sang¹¹, Li Jiang¹², Jiancheng Zhang¹, Wei Xiong¹, Jiao Liu¹³, Dechang Chen¹⁴

Affiliations

¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
³ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
⁴ Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
⁵ Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, China.
⁶ Department of Critical Care Medicine, Huadong Hospital, Shanghai, China.
⁷ Department of Critical Care Medicine, Renmin Hospital, Wuhan University, Wuhan, China.
⁸ Emergency Department, the 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, China.
⁹ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
¹¹ Department of Critical Care Medicine, The 1st Affiliated Hospital of GuangZhou Medical University, GuangZhou Institute of Respiratory Health, Guangzhou, China.
¹² Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹³ Department of Critical Care Medicine, Shanghai Jiaotong University, School of Medicine, Ruijin Hospital North, No. 197 Ruijin 2nd Road, Huangpu District, Shanghai, 201801, China.
¹⁴ Department of Critical Care Medicine, Shanghai Jiaotong University, School of Medicine, Ruijin Hospital North, No. 197 Ruijin 2nd Road, Huangpu District, Shanghai, 201801, China. chendechangsh@hotmail.com.

PMID: 32506258
PMCID: PMC7275657
DOI: 10.1186/s13613-020-00689-1

Review

Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

You Shang et al. Ann Intensive Care. 2020.

. 2020 Jun 6;10(1):73.

doi: 10.1186/s13613-020-00689-1.

Authors

Affiliations

¹ Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China.
³ Department of Critical Care Medicine, Zhejiang Provincial People's Hospital, Hangzhou Medical College, Hangzhou, China.
⁴ Department of Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
⁵ Department of Critical Care Medicine, Fujian Provincial Hospital, Fujian Provincial Center for Critical Care Medicine, Fuzhou, China.
⁶ Department of Critical Care Medicine, Huadong Hospital, Shanghai, China.
⁷ Department of Critical Care Medicine, Renmin Hospital, Wuhan University, Wuhan, China.
⁸ Emergency Department, the 900th Hospital of Joint Service Corps of Chinese PLA, Fuzhou, China.
⁹ Department of Critical Care Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
¹⁰ Department of Critical Care Medicine, The First Affiliated Hospital of Zhejiang University, Hangzhou, China.
¹¹ Department of Critical Care Medicine, The 1st Affiliated Hospital of GuangZhou Medical University, GuangZhou Institute of Respiratory Health, Guangzhou, China.
¹² Department of Critical Care Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China.
¹³ Department of Critical Care Medicine, Shanghai Jiaotong University, School of Medicine, Ruijin Hospital North, No. 197 Ruijin 2nd Road, Huangpu District, Shanghai, 201801, China.
¹⁴ Department of Critical Care Medicine, Shanghai Jiaotong University, School of Medicine, Ruijin Hospital North, No. 197 Ruijin 2nd Road, Huangpu District, Shanghai, 201801, China. chendechangsh@hotmail.com.

PMID: 32506258
PMCID: PMC7275657
DOI: 10.1186/s13613-020-00689-1

Abstract

Background: The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed.

Methods: Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences.

Results: A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations.

Conclusion: There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.

Keywords: COVID-19; Critical care; Expert statement.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

**Fig. 1**
Protocol of respiratory therapy for COVID-19-induced ARDS. *NIV* non-invasive ventilation, *HFNC* high-flow nasal cannula, *PBW* predict body weight, *ECMO* extracorporeal membrane oxygenation

See this image and copyright information in PMC

References

1. World Health Organization. Global Surveillance for human infection with coronavirus disease (COVID-19). 2020. https://www.who.int/publications-detail/global-surveillance-for-human-in...).
1. World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio....
1. World Health Organization, Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. https://who.int/publications-detail/clinical-management-of-severe-acute-....
1. The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)-China. China CDC Weekly. 2020;2:113–122. - PMC - PubMed
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Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

Affiliations

Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Medical