Severe Covid-19

ABSTRACT

Key Clinical PointsEvaluation and Management of Severe Covid-19Patients with severe coronavirus disease 2019 (Covid-19) may become critically ill with acute respiratory distress syndrome that typically begins approximately 1 week after the onset of symptoms.Deciding when a patient with severe Covid-19 should receive endotracheal intubation is an essential component of care.After intubation, patients should receive lung-protective ventilation with plateau pressure less than or equal to 30 cm of water and with tidal volumes based on the patient’s height.Prone positioning is a potential treatment strategy for refractory hypoxemia.Thrombosis and renal failure are well-recognized complications of severe Covid-19.Dexamethasone has been shown to reduce mortality among hospitalized patients with Covid-19 who require oxygen, particularly those receiving mechanical ventilation.Remdesivir was recently approved by the Food and Drug Administration for the treatment of Covid-19 in hospitalized patients, on the basis of randomized trials showing that the drug reduces time to clinical recovery;however, more data are needed to inform its role in treating severe Covid-19.