Chapter 15

Critical Care in COVID-19

Ozgur Karcioglu, Selman Yeniocak and Mandana Hosseinzadeh

Abstract

There are currently no recommended specific treatments for the group with severe COVID-19. Therefore , supportive treatment is essential. Expedient recognition and decisions for aggressive measures such as permanent control of the airway and positive-pressure ventilation, along with CST and t-PA administration, should be evaluated using certain selection criteria. Prone position is mostly associated with more favorable outcomes than supine position in the resuscitation of selected cases. Shock is also a catastrophic event that should be recognized and managed as early as possible for favorable outcomes. If the mean arterial pressure (MAP) cannot be kept above 65 mmHg with intravenous (IV) hydration and lactate cannot be maintained below 2 mmol/L, vasopressor support should definitely be initiated. Extracorporeal membrane oxygenation (ECMO) therapy is used in ARDS to temporarily maintain adequate O2 supply and CO2 elimination and / or provide perfusion in patients with respiratory and / or heart failure who do not respond to conventional interventions and whose physiological variables are abnormal despite maximal support. The development of coagulopathy is associated with high mortality in patients with COVID-19. Therefore, low molecular weight heparin (LMWH) should be used for prophylactic purposes. In order to reduce the incidence of VTE, it should be administered to patients with severe conditions and who are dependent on mechanical ventilation. Prophylactic LMWH will also benefit patients at high risk of VTE. The use of LMWH and anticoagulant therapy has been shown to reduce mortality in COVID19. The FDA has also recently approved the use of convalescent (immune) plasma therapy (CPT) in the COVID-19 era. Sera of the persons recovering from COVID-19 infection can be used in the prophylaxis or treatment of COVID-19 infection. CPT is one of the most important treatment options that can be used in pandemic COVID-19 infection. Antibody replacement by plasma infusion may be beneficial in the first 7-10 days of the disease. CPT is an important option for the prevention and treatment of COVID-19 disease in the presence of a sufficient number of people who can donate Ig-containing plasma. Patients treated with CP have a shorter hospital stay and lower mortality rates than other patients.

Total Pages: 301-364 (64)

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