Treatment of COVID-19 Pneumonia in the Critically Ill Patient Requiring High-Flow Oxygen or Ventilatory Support

This protocol applies to COVID-19 pneumonia in its most severe presentation — patients whose respiratory failure requires high-flow supplemental oxygen, noninvasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation (ECMO).

Critical illness in this context is defined by the need for mechanical ventilation or ECMO. Patients requiring high-flow oxygen or noninvasive ventilatory support are also included within this population. The clinical approach is distinct from that used in less severely ill hospitalised patients.

Treatment approach

Guideline-recommended management for this population centres on a specific corticosteroid regimen, with alternative agents designated for situations where the preferred choice is not available.

Full agent selection, timing, alternatives, and clinical guidance are available in the complete protocol below.

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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).

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