COVID-19 Critical Illness: A Data-Driven Review

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges in critical care medicine, including extreme demand for intensive care unit (ICU) resources and rapidly evolving understanding of a novel disease. Up to one-third of hospitalized patients with COVID-19 experience critical illness. The most common form of organ failure in COVID-19 critical illness is acute hypoxemic respiratory failure, which clinically presents as acute respiratory distress syndrome (ARDS) in three-quarters of ICU patients. Noninvasive respiratory support modalities are being used with increasing frequency given their potential to reduce the need for intubation. Determining optimal patient selection for and timing of intubation remains a challenge. Management of mechanically ventilated patients with COVID-19 largely mirrors that of non-COVID-19 ARDS. Organ failure is common and portends a poor prognosis. Mortality rates have improved over the course of the pandemic, likely owing to increasing disease familiarity, data-driven pharmacologics, and improved adherence to evidence-based critical care.

Keywords: ARDS; COVID-19; acute hypoxemic respiratory failure; acute respiratory distress syndrome; critical care; mechanical ventilation; noninvasive respiratory support.

Figure 1

Management of AHRF and ARDS in COVID-19 patients largely mirrors that for non-COVID-19 etiologies. Patients with COVID-19 may require airborne infectious precautions and other special considerations to minimize risk of viral transmission to healthcare workers. Though made challenging by limited visitation policies, family engagement remains essential throughout the course of critical illness. Adherence to critical care best practices under adverse conditions is key. Abbreviations: AHRF, acute hypoxemic respiratory failure; ARDS, acute respiratory distress syndrome; COVID-19, coronavirus disease 2019; ECMO, extracorporeal membrane oxygenation; HFNC, high-flow nasal cannula; NIV, noninvasive ventilation (including continuous positive airway pressure and bilevel positive airway pressure ventilation); NMB, neuromuscular blockade. Figure adapted from sticker2you/stock.adobe.com. Icon illustrations from thenounproject.com: “Oxygen mask,” by Sergey Demushkin; “Split,” by ImageCatalog; “Ventilator,” by Luis Prado; “Improve,” “Trending,” and “Care,” by Adrien Coquet.