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Review
. 2022 Apr;117(3):177-186.
doi: 10.1007/s00063-022-00909-5. Epub 2022 Mar 28.

[Diagnosis and treatment of COVID-19 in intensive care units]

[Article in German]
Wolfgang Hoepler  1 , Marianna Traugott  1 , Alexander Zoufaly  1   2 , Martina Schatzl  1 , Julian Hind  1 , Christoph Wenisch  3 , Stephanie Neuhold  1
Affiliations
Review

[Diagnosis and treatment of COVID-19 in intensive care units]

[Article in German]
Wolfgang Hoepler et al. Med Klin Intensivmed Notfmed. 2022 Apr.

Abstract
in English, German

Treatment of coronavirus disease 2019 (COVID-19) is particularly challenging due to the rapid scientific advances and the often significant hypoxemia. Use of high-flow oxygen, noninvasive mask ventilation, and the technique of awake proning can sometimes avoid the need for intubation. Mechanical ventilation follows the principles of ventilation for acute respiratory distress syndrome (ARDS; lung protective ventilation) and is generally supplemented by consequent positioning therapy (with at least 16 h in prone position in multiple cycles). Antiviral therapy options such as remdesivir usually come too late for patients with COVID-19 in the ICU, the only exception being the administration of monoclonal antibodies for patients without seroconversion. The value of immunomodulatory therapy such as dexamethasone is undisputed. Interleukin‑6 antagonists, on the other hand, are rather problematic for ICU patients, and for Janus kinase inhibitors, data and experience are still insufficient in this context.

Die Therapie von „coronavirus disease 2019“ (COVID-19) ist aufgrund der Rasanz des wissenschaftlichen Erkenntnisgewinns und des oft extremen Ausmaßes der Hypoxämie äußerst herausfordernd. Mittels Hochflusssauerstoff, nichtinvasiver Maskenbeatmung und der Technik des „awake proning“ kann manchmal eine Intubation verhindert werden. Die maschinelle Beatmung folgt den Grundsätzen der Beatmung bei Acute Respiratory Distress Syndrome (ARDS; lungenprotektive Beatmung) und wird sinnhafterweise durch konsequente Lagerungstherapie (mit mindestens 16 h in Bauchlage in mehreren Zyklen) ergänzt. Antivirale Therapieoptionen wie Remdesivir kommen bei Intensivpatienten mit COVID-19 üblicherweise zu spät, einzige Ausnahme ist die Gabe von monoklonalen Antikörpern für Patientinnen und Patienten ohne Serokonversion. Unbestritten ist der Stellenwert der immunmodulierenden Therapie wie Dexamethason; Interleukin-6-Antagonisten sind für Intensivpatienten dagegen eher problembehaftet und für Januskinaseinhibitoren sind Datenlage und Erfahrungsschatz in diesem Kontext noch unzureichend.

Keywords: Intratracheal intubation; Monoclonal antibodies; Non-invasive ventilation; Oxygen inhalation therapy; Steroids.

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