Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection

Abstract

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).

Psychological support to relatives of critically ill patients with COVID-19

“…Due to the pandemic of the coronavirus disease 2019 (COVID-19), thousands of scientific studies, ( 1 , 2 ) as well as diverse treatment protocols, ( 3 , 4 ) have been reported in the literature. So far, in the absence of vaccines against the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), it has been a routine to care for severe COVID-19 patients at intensive care units, who are on invasive mechanical ventilation for several days; on average, during three weeks.…”

“…Diante da pandemia da doença pelo coronavírus 2019 (COVID-19), milhares de estudos científicos têm sido divulgados na literatura, ( 1 , 2 ) bem como variados protocolos de tratamento. ( 3 , 4 ) Até o momento, na ausência de vacinas contra o coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), é corriqueiro o atendimento a pacientes graves com COVID-19 em unidades de terapia intensiva com uso de ventilação mecânica invasiva por vários dias – em média durante 3 semanas. ( 1 ) Essa fase do tratamento deve certamente implicar em importantes impactos psicológicos envolvendo os familiares desses pacientes, dado que visitas não são permitidas e ainda não há um medicamento específico contra o SARS-CoV-2.…”

Comment to: Intensive support recommendations for critically-ill patients with suspected or confirmed COVID-19 infection

“…Dear Editor, In this issue of einstein journal (São Paulo), Corrêa et al, reported intensive support recommendations for critically-ill patients with suspected or confirmed infection by the new coronavirus (COVID-19). (1) Based on preliminary demonstration of efficacy of chloroquine, the authors suggested the use of hydroxychloroquine in monotherapy or combined with a macrolide (azithromycin or clarithromycin), to treat severe patients with COVID-19, admitted to the intensive care unit (ICU), to inhibit in vitro replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). (2) However, evidence from observational studies (3,4) involving hospitalized COVID-19 patients demonstrated the use of hydroxychloroquine in monotherapy (3) or combined with a macrolide (4) was not associated with reduced mortality when compared to patients who did not receive such medications (controls).…”

“…In this issue of einstein journal (São Paulo), Corrêa et al, reported intensive support recommendations for critically-ill patients with suspected or confirmed infection by the new coronavirus (COVID-19). ( 1 ) Based on preliminary demonstration of efficacy of chloroquine, the authors suggested the use of hydroxychloroquine in monotherapy or combined with a macrolide (azithromycin or clarithromycin), to treat severe patients with COVID-19, admitted to the intensive care unit (ICU), to inhibit in vitro replication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). ( 2 )…”

“…Nesta edição da revista einstein (São Paulo), Corrêa et al, reportam recomendações de suporte intensivo para pacientes graves com infecção suspeita ou confirmada por doença pelo coronavírus 19 (COVID-19). ( 1 ) Com base na demonstração preliminar da eficácia da cloroquina, os autores sugeriram, para tratamento de pacientes graves admitidos em unidade de terapia intensiva (UTI) com COVID-19, ( 1 ) a utilização da hidroxicloroquina em monoterapia ou em associação com um macrolídeo (azitromicina ou claritromicina), de modo a inibir a replicação in vitro do coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2). ( 2 )…”