COVID-19 Critical Care
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Complications and Prognosis
Screening and Prevention
Current standard treatment options include infection control measures, routine supportive care, and medications including antiviral, monoclonal antibody, immunomodulator, and corticosteroid drugs
Infection control measures include isolation, source control, and transmission precautions r73
Initiate supportive care for hospitalized patients, including oxygenation and ventilation, conservative fluid support, and measures to prevent common complications (eg, pressure injury, stress ulceration, secondary infection) r5
Corticosteroid therapy is suggested or recommended for hospitalized patients with an oxygen requirement r1r6r71r72
Immunomodulators are used for mitigation of cytokine release syndrome believed to be a factor in severe acute respiratory distress syndrome and shock in COVID-19 (eg, monoclonal antibodies against interleukin-6 receptors, such as tocilizumabr83 and sarilumabr84; Janus kinase inhibitors such as baricitinibr85 and tofacitinibr86; monoclonal antibody vilobelimabr87 against complement activity)
Several antiviral agents (eg, remdesivir, ritonavir-boosted nirmatrelvir, molnupiravir) with action against SARS-CoV-2 are now available, primarily for prevention of severe disease and not for use in critically ill patients. However, remdesivir is FDA-approved for treatment of SARS-CoV-2–positive adults and children aged 28 days or older weighing 3 kg or more who are hospitalized (as well as nonhospitalized patients who are at high risk of progression to severe disease) r100r101
Medications including monoclonal antibodies against SARS-CoV-2 spike protein and convalescent plasma may be used in prevention or treatment of COVID-19 but have no role for critically ill patients
Several medications with a mechanism of action which could potentially alter response to COVID-19 have been evaluated either for use in treatment and prevention, or for discontinuation to prevent harms r102
Several other treatments are not currently recommended under any guidelines but continue to be studied; avoid use outside clinical trials
Excellent supportive care remains the mainstay of treatment to date in COVID-19 c59
WHO,r5NIH,r1 and Surviving Sepsis Campaignr6 provide specific guidance for oxygenation, ventilation, hemodynamics, fluid management, and prevention of complications in COVID-19
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