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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2021

Open Access 01-12-2021 | SARS-CoV-2 | Review

Intensive care management of patients with COVID-19: a practical approach

Authors: Ludhmila Abrahão Hajjar, Isabela Bispo Santos da Silva Costa, Stephanie Itala Rizk, Bruno Biselli, Brenno Rizerio Gomes, Cristina Salvadori Bittar, Gisele Queiroz de Oliveira, Juliano Pinheiro de Almeida, Mariana Vieira de Oliveira Bello, Cibele Garzillo, Alcino Costa Leme, Moizo Elena, Fernando Val, Marcela de Almeida Lopes, Marcus Vinícius Guimarães Lacerda, José Antonio Franchini Ramires, Roberto Kalil Filho, Jean-Louis Teboul, Giovanni Landoni

Published in: Annals of Intensive Care | Issue 1/2021

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Abstract

SARS-CoV-2, the causative agent of coronavirus disease 2019 (COVID-19), is responsible for the largest pandemic facing humanity since the Spanish flu pandemic in the early twentieth century. Since there is no specific antiviral treatment, optimized support is the most relevant factor in the patient's prognosis. In the hospital setting, the identification of high-risk patients for clinical deterioration is essential to ensure access to intensive treatment of severe conditions in a timely manner. The initial management of hypoxemia includes conventional oxygen therapy, high-flow nasal canula oxygen, and non-invasive ventilation. For patients requiring invasive mechanical ventilation, lung-protective ventilation with low tidal volumes and plateau pressure is recommended. Cardiovascular complications are frequent and include myocardial injury, thrombotic events, myocarditis, and cardiogenic shock. Acute renal failure is a common complication and is a marker of poor prognosis, with significant impact in costs and resources allocation. Regarding promising therapies for COVID-19, the most promising drugs until now are remdesivir and corticosteroids although further studies may be needed to confirm their effectiveness. Other therapies such as, tocilizumab, anakinra, other anti-cytokine drugs, and heparin are being tested in clinical trials. Thousands of physicians are living a scenario that none of us have ever seen: demand for hospital exceed capacity in most countries. Until now, the certainty we have is that we should try to decrease the number of infected patients and that an optimized critical care support is the best strategy to improve patient’s survival.
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Metadata
Title
Intensive care management of patients with COVID-19: a practical approach
Authors
Ludhmila Abrahão Hajjar
Isabela Bispo Santos da Silva Costa
Stephanie Itala Rizk
Bruno Biselli
Brenno Rizerio Gomes
Cristina Salvadori Bittar
Gisele Queiroz de Oliveira
Juliano Pinheiro de Almeida
Mariana Vieira de Oliveira Bello
Cibele Garzillo
Alcino Costa Leme
Moizo Elena
Fernando Val
Marcela de Almeida Lopes
Marcus Vinícius Guimarães Lacerda
José Antonio Franchini Ramires
Roberto Kalil Filho
Jean-Louis Teboul
Giovanni Landoni
Publication date
01-12-2021
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2021
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-021-00820-w

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