Abstract
We reported an early COVID-19 case in a young patient in a Canadian community intensive care unit (ICU) with severe acute respiratory syndrome (ARDS). We discussed the management according to the recently published Surviving Sepsis Guidelines on COVID-19. This will provide critical care physicians important and timely information on the management of severe COVID-19 using a real case when critical care physicians are facing a surge in COVID-19 cases.
Highlights
Case presentation: This is a case of a 39-year-old patient in a community intensive care unit (ICU) in Southern Ontario, Canada, with severe COVID-19 complicated by circulatory shock requiring vasopressor support; severe acute respiratory distress syndrome (ARDS) requiring lung protective ventilation, use of a neuromuscular blocking agent, proning, systemic corticosteroids and conservative fluid management; and acute kidney injury requiring intermittent hemodialysis
In December 2019, there was an emergence of a novel coronavirus that caused a cluster of pneumonia cases in Wuhan, China, known as the coronavirus disease (COVID-19)
The number of critically ill patients with COVID-19 who will require intensive care unit (ICU) beds is expected to rise across the globe in the coming weeks
Summary
Healthcare professionals in critical care will face a continued surge of critically ill COVID-19 patients with ARDS in the coming weeks to months. Due to the infectious nature of this disease, inter-hospital transfer of these types of patients for higher levels of care will be limited. As such, both academic and community ICUs must be equipped to manage these critically ill patients with COVID-19. ICU: Intensive Care Unit; ARDS: Acute Respiratory Syndrome; WHO: World Health Organization; COVID-19: Novel Corona Virus disease; SSC: Surviving Sepsis Campaign; PEEP: Positive End Expiratory Pressure; FiO2: Fraction of Inspire Oxygen; NMBA: Neuromuscular Blocking Agent; PCR: Polymerase Chain Reaction; ARB: Angiotensin Receptor Blocker; LTVV: Low Tidal Volume Ventilation; VILI: Ventilator-Induced Lung Injury; ETT: Endotracheal Tube; PPE: Personal Protective Equipment; PROSEVA: Prone Positioning in Severe Acute Respiratory Distress Syndrome; ACE2: Angiotensin Converting Enzyme 2; RAAS: Renin-Angiotensin-Aldosterone System; CATCO: Multi-Center, Adaptive, Randomized, Open-label, Controlled Clinical Trial of the Safety and Efficacy of Investigational Therapeutics for the Treatment of COVID-19 in Hospitalized Patients; ACT: Anti-Coronavirus Therapies to prevent progression of COVID-19; INR: International Normalized Ratio; AST: Aspartate Aminotransferase; ALT: Alanine Aminotransferase; ALP: Alkaline Phosphatase; IFEU: Fibrinogen Equivalent Unit.
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