COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen

ABSTRACT

Approximately 14% of COVID-19 patients have a more severe and approximately 5% a critical course of disease. The elderly, males, smokers, and severely obese people are particularly at risk. If the patient is ventilated invasively or non-invasively, mortality rises to 53% and 50% respectively. As a rule, it takes ten days from the onset of symptoms to admission to the intensive care unit. The average length of stay in the intensive care unit is nine days. Prioritization is based on the clinical chances of success of intensive care treatment and the patient 's wishes. Central criteria for admission to the intensive care unit are hypoxemia (SpO(2) < 90% by admitting 2-4 liters of oxygen/min., if no pre-existing therapy is used), dyspnea, an increased respiratory rate (> 25-30/min) and systolic blood pressure = 100mmHg. The protection of the personnel has priority in all measures. All aerosol generating procedures should be performed with great care. If adequate oxygenation is not achieved under high flow (SpO(2) >= 90% or a paO(2) > 55mmHg), escalation should be considered (NIV, invasive ventilation). The patients should be ventilated lung-protectively. Intubation should be performed as rapid sequence induction. An ECMO can be considered. Thromboembolic complications are very frequent. Antibiotics should not be given routinely. The best data currently available is for dexamethasone. Remdesivir can accelerate the convalescence. Longterm consequences after COVID-19 are very common. Cardiac, pulmonary, and neurological problems are in the foreground.