In December 2019, a series of patients with severe pneumonia were identified in Wuhan, Hubei province, China, who progressed to severe acute respiratory syndrome and acute respiratory distress syndrome. Subsequently, COVID-19 was attributed to a new betacoronavirus, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Approximately 20% of patients diagnosed as COVID-19 develop severe forms of the disease, including acute hypoxemic respiratory failure, severe acute respiratory syndrome, acute respiratory distress syndrome and acute renal failure and require intensive care. There is no randomized controlled clinical trial addressing potential therapies for patients with confirmed COVID-19 infection at the time of publishing these treatment recommendations. Therefore, these recommendations are based predominantly on the opinion of experts (level C of recommendation).
Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection
CorrêaTD, MatosGFJ, BravimBA, CordioliRL, GarridoAPG, AssuncaoMSC, BarbasCSV, et al. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection. einstein (São Paulo). 2020;18:eAE5793. https://doi.org/10.31744/einstein_journal/2020AE5793
Corrêa,Thiago Domingos; Matos,Gustavo Faissol Janot de; Bravim,Bruno de Arruda; Cordioli,Ricardo Luiz; Garrido,Alejandra del Pilar Gallardo; Assuncao,Murillo Santucci Cesar de; Barbas,Carmen Silvia Valente; Timenetsky,Karina Tavares; Rodrigues,Roseny dos Reis; Guimarães,Hélio Penna; Rabello Filho,Roberto; Lomar,Frederico Polito; Scarin,Farah Christina de La Cruz; Batista,Carla Luciana; Pereira,Adriano José; Guerra,João Carlos de Campos; Carneiro,Bárbara Vieira; Nawa,Ricardo Kenji; Brandão,Rodrigo Martins; Pesaro,Antônio Eduardo Pereira; Silva Júnior,Moacyr; Carvalho,Fabricio Rodrigues Torres de; Silva,Cilene Saghabi de Medeiros; Almeida,Ana Claudia Ferraz de; Franken,Marcelo; Pesavento,Marcele Liliane; Eid,Raquel Afonso Caserta; Ferraz,Leonardo José Rolim. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection. einstein (São Paulo), São Paulo, v. 18, eAE5793, May. 2020. https://doi.org/10.31744/einstein_journal/2020AE5793
Corrêa,Thiago Domingos and Matos,Gustavo Faissol Janot de and Bravim,Bruno de Arruda and Cordioli,Ricardo Luiz and Garrido,Alejandra del Pilar Gallardo and Assuncao,Murillo Santucci Cesar de and Barbas,Carmen Silvia Valente and Timenetsky,Karina Tavares and Rodrigues,Roseny dos Reis and Guimarães,Hélio Penna and Rabello Filho,Roberto and Lomar,Frederico Polito and Scarin,Farah Christina de La Cruz and Batista,Carla Luciana and Pereira,Adriano José and Guerra,João Carlos de Campos and Carneiro,Bárbara Vieira and Nawa,Ricardo Kenji and Brandão,Rodrigo Martins and Pesaro,Antônio Eduardo Pereira and Silva Júnior,Moacyr and Carvalho,Fabricio Rodrigues Torres de and Silva,Cilene Saghabi de Medeiros and Almeida,Ana Claudia Ferraz de and Franken,Marcelo and Pesavento,Marcele Liliane and Eid,Raquel Afonso Caserta and Ferraz,Leonardo José Rolim. Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection. einstein (São Paulo) [online]. 2020, vol. 18, [cited 2024-03-28], eAE5793. Available from: <https://journal.einstein.br/article/intensive-support-recommendations-for-critically-ill-patients-with-suspected-or-confirmed-covid-19-infection/>. ISSN 1679-4508. https://doi.org/10.31744/einstein_journal/2020AE5793
Figure 2
Flow chart for mechanical ventilation in patients with suspected or confirmed diagnosis of COVID-19
* If increase in partial pressure of arterial CO2 and pH <7.20, evaluate the possibility of reducing PEEP by 2cmH2O and reassess; † PEEP mini titration with the PEEP parameters 25cmH2O and delta PP 15cmH2O for 5 minutes. Optimize sedation and NMB; ‡ follow prone MV protocol. If no response, perform PEEP mini titration again. Adjust PEEP to 18cmH2O.
OTI: orotracheal intubation; MV: mechanical ventilation; PaO 2 /FiO 2 : partial arterial oxygen pressure and inspired oxygen fraction; PEEP: positive end-expiratory pressure; CO 2 : carbon dioxide; SpO 2 : peripheral oxygen saturation; prone MV: mechanical ventilation in prone position; PCV: pressure-controlled volume; VT: tidal volume; RR: respiratory rate; PP: positive pressure; NMB: neuromuscular blocker.