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 Pao2/Fio2≤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.
Management of critically ill patients with coviD-19 : suggestions and instructions from the coordination of intensive care units of Lombardy / G. Foti, A. Giannini, N. Bottino, G.P. Castelli, M. Cecconi, G. Grasselli, L. Guatteri, N. Latronico, T. Langer, G. Monti, S. Muttini, A. Pesenti, D. Radrizzani, M. Ranucci, V. Russotto, R. Fumagalli. - In: MINERVA ANESTESIOLOGICA. - ISSN 0375-9393. - 86:11(2020), pp. 1234-1245.
|Titolo:||Management of critically ill patients with coviD-19 : suggestions and instructions from the coordination of intensive care units of Lombardy|
|Parole Chiave:||Critical Illness; Humans; Intensive Care Units; Italy; Pandemics; COVID-19; Coronavirus|
|Settore Scientifico Disciplinare:||Settore MED/41 - Anestesiologia|
|Data di pubblicazione:||2020|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.23736/S0375-9393.20.14762-X|
|Appare nelle tipologie:||01 - Articolo su periodico|