Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

Abstract

Background The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed. Methods Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences. Results A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts’ opinions. A strong agreement from voting participants was obtained for all recommendations. Conclusion There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.

Tracheostomy in 80 COVID-19 patients: a multicenter, retrospective, observational study

“…Sixty (69.0%) patients had chronic medical illnesses, and the most common illnesses were hypertension (40.0%), coronary heart disease (21.1%), diabetes (17.5%) and cerebrovascular disease (10.0%) ( Table 1). Thirty (37.5%) patients received tracheostomies within 14 days after intubation, and their median duration between intubation and tracheostomy was signi cantly shorter than that of the late tracheostomy group ( [11][12][13][14][15][16][17][18][19][20][21], p = 0.034) at ICU admission and lower APACHE II scores (13 (SD 4) vs 17 (SD 6), p = 0.010) before tracheostomy. Among all 80 patients, lymphocytopenia and hypoalbuminemia at hospital admission and hypoxemia at ICU admission were prominent (Table 2).…”

“…Most clinicians were concerned with the aerosol-generating risk while conducting tracheostomies in patients with COVID-19, so optimal management should be applied in the tracheostomy procedure to maintain the safety of operators [11]. In our study, most procedures were performed by ICU physicians using percutaneous techniques at bedside, which avoided the unnecessary transport of ventilated patients and repeated connection and disconnection of ventilatory circuits during transfer.…”

“…However, tracheostomies within 14 days of endotracheal intubation should be avoided. [4,7] 6 [4,9] 5 [4,7] 0.014 APACHE II score 12 [9,18] 15 [11,21] 11 [9,17] Data were presented as count (%).…”

Symptoms of burnout in intensive care unit specialists facing the COVID-19 outbreak

“…With more than six million confirmed cases worldwide and more than 350,000 deaths between February and May 2020, the COVID-19 pandemic has emerged as an unprecedented healthcare crisis [1][2][3]. Increasing work demands on healthcare professionals cause psychological stress.…”

Aspectos fisiopatológicos do COVID-19 e uso de ventilação não invasiva. É possível?

“…Segundo as Diretrizes Brasileiras de Ventilação Mecânica, em população hipoxêmica, o índice de sucesso da VNI para evitar intubação orotraqueal e demais complicações, pode ser de 50% 16,21,22 . Já outro estudo sugere que a tentativa de VNI deve ser indicada quando a relação PaO2/FiO2 estiver maior ou igual a 150 mmHg 23 .…”