Ten things you need to know about intensive care unit management of mechanically ventilated patients with COVID-19

Abstract

Introduction: The ongoing pandemic caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has posed important challenges for clinicians and health-care systems worldwide.Areas covered: The aim of this manuscript is to provide brief guidance for intensive care unit management of mechanically ventilated patients with COVID-19 based on the literature and our direct experience with this population. PubMed, EBSCO, and the Cochrane Library were searched up until 15th of January 2021 for relevant literature.Expert opinion: Initially, the respiratory management of COVID-19 relied on the general therapeutic principles for acute respiratory distress syndrome; however, recent findings have suggested that the pathophysiology of hypoxemia in patients with COVID-19 presents specific features and changes over time. Several therapies, including antiviral and anti-inflammatory agents, have been proposed recently. The optimal intensive care unit management of patients with COVID-19 remains unclear; therefore, ongoing and future clinical trials are warranted to clarify the optimal strategies to adopt in this cohort of patients.

Keywords: Severe acute respiratory syndrome coronavirus-2; antibiotic therapy; anticoagulation; corticosteroids; mechanical ventilation.

Figure 1.

Clinical approach to patients with COVID-19 in the intensive care unit in Genoa, Italy. CPAP, continuous positive airway pressure; CRP, C-reactive protein; CT, computed tomography; ΔVACO2; delta veno-arterial carbon dioxide; P, driving pressure; ECMO, extracorporeal membrane oxygenation membrane; HFNO, high-flow nasal oxygen; iNO, inhaled nitric oxide; LMWH, low-molecular-weight heparin; VT, tidal volume; PBW, predicted body weight; PCT, procalcitonin; PEEP, positive end-expiratory pressure; MAP, mean arterial pressure; Pplat, plateau pressure; ScVO2, ventral venous oxygen saturation; UFH, unfractionated heparin; WBC, white blood cells