Critical care management of COVID-19 patients

COVID-19, the respiratory viral infection caused by the SARS-CoV-2 virus, has globally resulted in hundreds of millions of cases and millions of deaths and continues to have a profound impact as new variants arise and spread. The spectrum of disease caused by COVID-19 varies from asymptomatic to severe, with definitions for purposes of management heavily relying on the level of respiratory support required. The National Institutes of Health defines disease severity first based on if the patient requires hospitalization or supplemental oxygen, with severity increasing based on categories of hospitalization in the following order: not requiring supplemental oxygen, requiring supplemental oxygen, requiring oxygen via high-flow or noninvasive ventilation, and finally, the most severe cases requiring invasive mechanical ventilation and/or extracorporeal membrane oxygenation (ECMO). Unlike invasive mechanical ventilation, in which the patient’s lungs are utilized for oxygenation and removal of carbon dioxide, ECMO can replace lung function by allowing for gas exchange and resting the diseased and damaged lungs. Additionally, the Surviving Sepsis guidelines updated for COVID-19 provide clinical criteria regarding severity of illness based on clinical signs of pneumonia, which align with those of the World Health Organization.