Abstract
The outbreak of coronavirus disease 2019 (COVID-19) was declared a global pandemic after it spread to 213 countries and has the highest total number of cases worldwide. About 80% of COVID-19 infections are mild or asymptomatic and never require hospitalization but about 5% of patients become critically ill and develop acute respiratory distress syndrome (ARDS). The widely used management for ARDS in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation. Treatment options for this widespread disease are limited and there are no definitive therapies or vaccines until now. Although some antimalarial and antiviral drugs may prove effective against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), their safety and efficacy are still under clinical trials. We conducted a systematic review of case reports on ARDS in SARS-CoV-2 infection to summarize the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. We need more data and established studies for the effective management of the novel SARS-CoV-2 and to reduce mortality in high-risk patients.
Highlights
BackgroundAn outbreak of a cluster of cases of pneumonia with an unknown cause was first reported in late December 2019 in Wuhan in the Hubei Province of China
The outbreak of coronavirus disease 2019 (COVID-19) was declared a global pandemic after it spread to 213 countries and has the highest total number of cases worldwide
The widely used management for acute respiratory distress syndrome (ARDS) in COVID-19 has been in line with the standard approach, but the need to adjust the treatment protocols has been questioned based on the reports of higher mortality risk among those requiring mechanical ventilation
Summary
An outbreak of a cluster of cases of pneumonia with an unknown cause was first reported in late December 2019 in Wuhan in the Hubei Province of China. In this systematic review based on findings of previously published case reports on ARDS in SARS-CoV-2 infection, we have comprehensively summarized the clinical presentation, laboratory and chest imaging findings, management protocols, and outcome of ARDS in COVID-19-positive patients. The study on tPA treatment for COVID-19-associated ARDS, which involved measuring the partial pressure of oxygen (PaO2)/fraction of inspired oxygen (FiO2) ratio for oxygenation status, reported one out of three cases had 100% improvement post-tPA but the effect was transient [6]. This case series mentions the use of anticoagulants like heparin with tPA infusion to decrease the risk of bleeding [6]. Patient developed severe hypoxemia requiring 100% NRB after two days of O2 supplementation
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