علاج التهاب رئة كوفيد-19 لدى المرضى الحرجين الذين يحتاجون إلى الأكسجين عالي التدفق، أو التهوية غير الغازية، أو التهوية الميكانيكية، أو الأوكسجة بالغشاء خارج الجسم

References

DOI: 10.1093/cid/ciac724

• Among hospitalized critically ill patients with COVID-19, the IDSA guideline panel recommends dexamethasone rather than no dexamethasone.
• Critical illness is defined as patients on mechanical ventilation and extracorporeal membrane oxygenation (ECMO).
• Among hospitalized adults with progressive severe or critical COVID-19 who have elevated markers of systemic inflammation, the IDSA guideline panel suggests tocilizumab in addition to standard of care (ie, steroids) rather than standard of care alone.
• In addition to corticosteroids, we recommend using either IL-6 inhibitors (tocilizumab preferred over sarilumab) or JAK inhibitors (baricitinib preferred over tofacitinib) in patients who have elevated inflammatory markers (eg, CRP), which most critically ill patients with COVID-19 have.
• In situations where IL-6 inhibitors are not available, baricitinib can be used in mechanically ventilated patients, as a small trial showed a mortality benefit in this population.