Intensive Care Management of Corona Virus Disease

Alessandri, F.; Giordano, G.; Magnanimi, E.; Bilotta, F.

The COVID-19 pandemic imposed a sudden expansion of medical and ICU capability in order to deal with an unprecedented and overwhelming number of patients needing ventilatory support and intensive care. The request for new ICU beds has risen worldwide, due to the rapid spreading of the infection and was faced with structural and functional reorganization of preexisting spaces and to the creation of new facilities. The necessity to minimize in-hospital spreading of the infection and to ensure adequate management of patients were both crucial in reconsidering the logistic of preexisting and new spaces and equipment allocation. Despite limited evidence from COVID-19 patients, clinical management evolved according to local experience and guidelines released by national and international committees and scientific societies. In the majority of cases, initial therapeutic strategies were based on adapting available recommendations regarding “similar diseases” (e.g., sepsis, acute respiratory distress syndrome-ARDS, etc.). Subsequently, new evidence highlighted specific features of COVID-19 and were implemented into previously released guidelines. These include ICU admission, respiratory support, management of hemodynamic failure, and appropriate adjuvant therapies (coagulopathy, nutrition, associated infections). Furthermore, the COVID-19 surge shaded a new light on the relevance of dedicated communication needs for both healthcare providers and patients.