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Name of Media:
the bmj|BMJ 2021;372:n436 | doi: 10.1136/bmj.n4361State of the art reVIeWSevere covid-19 pneumonia: pathogenesis and clinical management
Amy H Attaway, Rachel G Scheraga, Adarsh Bhimraj, Michelle Biehl, Umur Hatipoğlu
Publisher or Source:
Type of Media:
Media Originally for:
Critical Care Physicians,General Medical Professionals,Nurses and/or Other Critical Care Medical Professionals
Country of Origin:
United States of America (the)
Primary Focus of Media:
Post Intensive Care Syndrome (PICS)
Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission.
During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.
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