As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19 but also to health-care workers and other patients who are at risk from the nosocomial transmission. Management of acute respiratory failure and hemodynamics is key. ICU practitioners, hospital administrators, governments, and policymakers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.
- Clinical features of coronavirus disease 2019 (COVID-19) are non-specific and do not easily distinguish it from other causes of severe community-acquired pneumonia
- As the pandemic worsens, intensive care unit (ICU) practitioners should increasingly have a high index of suspicion and a low threshold for diagnostic testing for COVID-19
- Many questions on clinical management remain unanswered, including the significance of myocardial dysfunction, and the role of non-invasive ventilation, high-flow nasal cannula, corticosteroids, and various repurposed and experimental therapies
- ICU practitioners, hospital administrators, governments, and policymakers must prepare early for a substantial increase in critical care capacity, or risk being overwhelmed by the pandemic
- Surge options include the addition of beds to a pre-existing ICU, provision of intensive care outside ICUs, and centralization of intensive care in designated ICUs while considering critical care triage and rationing of resources should surge efforts be insufficient
- Preparations must focus not just on infrastructure and supplies, but also on staff, including protection from nosocomial transmission and promotion of mental wellbeing
This list is a brief compilation of some of the key recommendations included in the document and is not exhaustive and does not constitute medical advice.
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