Management of critically ill patients with COVID-19: suggestions and instructions from the coordination of intensive care units of Lombardy
| Autor: | Giacomo Grasselli, Gian Paolo Castelli, N Bottino, Luca Guatteri, Giuseppe Foti, Antonio Pesenti, Maurizio Cecconi, Marco Ranucci, Danilo Radrizzani, Giacomo Monti, Alberto Giannini, Nicola Latronico, Roberto Fumagalli, Thomas Langer, Stefano Muttini, Vincenzo Russotto |
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| Přispěvatelé: | Foti, G., Giannini, A., Bottino, N., Castelli, G. P., Cecconi, M., Grasselli, G., Uatteri, L., Latronico, N., Langer, T., Monti, G., Muttini, S., Pesenti, A., Radrizzani, D., Ranucci, M., Russotto, V., Fumagalli, R (COVID-19 Lombardy ICU Network), Zangrillo, A, Landoni, G, Foti, G, Giannini, A, Bottino, N, Castelli, G, Cecconi, M, Grasselli, G, Guatteri, L, Latronico, N, Langer, T, Monti, G, Muttini, S, Pesenti, A, Radrizzani, D, Ranucci, M, Russotto, V, Fumagalli, R |
| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Respiratory distress syndrome medicine.medical_treatment Critical Illness Psychological intervention MEDLINE law.invention 03 medical and health sciences 0302 clinical medicine 030202 anesthesiology law Intensive care medicine Humans Continuous positive airway pressure Intensive care medicine Pandemics Mechanical ventilation business.industry adult COVID-19 030208 emergency & critical care medicine Intensive Care Units Italy Coronavirus medicine.disease Intensive care unit Pneumonia Anesthesiology and Pain Medicine Respiratory failure ARDS business |
| Zdroj: | Minerva anestesiologica. 86(11) |
| ISSN: | 1827-1596 |
| Popis: | With 63,098 confirmed cases on 17 April 2020 and 11,384 deaths, Lombardy has been the most affected region in Italy by coronavirus disease 2019 (COVID-19). To cope with this emergency, the COVID-19 Lombardy intensive care units (ICU) network was created. The network identified the need of defining a list of clinical recommendations to standardize treatment of patients with COVID-19 admitted to Intensive Care Unit (ICU). Three core topics were identified: 1) rational use of intensive care resources; 2) ventilation strategies; 3) non-ventilatory interventions. Identification of patients who may benefit from ICU treatment is challenging. Clinicians should consider baseline performance and frailty status and they should adopt disease-specific staging tools. Continuous positive airway pressure, mainly delivered through a helmet as elective method, should be considered as initial treatment for all patients with respiratory failure associated with COVID-19. In case of persisting dyspnea and/or desaturation despite 4-6 hours of noninvasive ventilation, endotracheal intubation and invasive mechanical ventilation should be considered. In the early phase, muscle relaxant use and volume-controlled ventilation is recommended. Prone position should be performed in patients with PaOinf2/inf/FiOinf2/inf≤100 mmHg. For patients admitted to ICU with COVID-19 interstitial pneumonia, we do not recommend empiric antibiotic therapy for community-acquired pneumonia. Consultation of an infectious disease specialist is suggested before start of any antiviral therapy. In conclusion, the COVID-19 Lombardy ICU Network identified a list of best practice statements supported by the available evidence and clinical experience or identified as panel members expert opinions for the management of critically ill patients with COVID-19. |
| Databáze: | OpenAIRE |
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