TY - JOUR
T1 - Clinical update on COVID-19 for the emergency clinician
T2 - Airway and resuscitation
AU - Chavez, Summer
AU - Brady, William J.
AU - Gottlieb, Michael
AU - Carius, Brandon M.
AU - Liang, Stephen Y.
AU - Koyfman, Alex
AU - Long, Brit
N1 - Publisher Copyright:
© 2022
PY - 2022/8
Y1 - 2022/8
N2 - Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Objective: This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19. Discussion: Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4–8 mL/kg of predicted body weight and targeted plateau pressures <30 cm H2O. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO). Conclusion: This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians.
AB - Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Objective: This narrative review provides emergency clinicians with a focused update of the resuscitation and airway management of COVID-19. Discussion: Patients with COVID-19 and septic shock should be resuscitated with buffered/balanced crystalloids. If hypotension is present despite intravenous fluids, vasopressors including norepinephrine should be initiated. Stress dose steroids are recommended for patients with severe or refractory septic shock. Airway management is the mainstay of initial resuscitation in patients with COVID-19. Patients with COVID-19 and ARDS should be managed similarly to those ARDS patients without COVID-19. Clinicians should not delay intubation if indicated. In patients who are more clinically stable, physicians can consider a step-wise approach as patients' oxygenation needs escalate. High-flow nasal cannula (HFNC) and non-invasive positive pressure ventilation (NIPPV) are recommended over elective intubation. Prone positioning, even in awake patients, has been shown to lower intubation rates and improve oxygenation. Strategies consistent with ARDSnet can be implemented in this patient population, with a goal tidal volume of 4–8 mL/kg of predicted body weight and targeted plateau pressures <30 cm H2O. Limited data support the use of neuromuscular blocking agents (NBMA), recruitment maneuvers, inhaled pulmonary vasodilators, and extracorporeal membrane oxygenation (ECMO). Conclusion: This review presents a concise update of the resuscitation strategies and airway management techniques in patients with COVID-19 for emergency medicine clinicians.
KW - COVID-19
KW - Coronavirus-2019
KW - SARS-CoV-2
KW - Severe acute respiratory syndrome coronavirus 2
UR - http://www.scopus.com/inward/record.url?scp=85131119222&partnerID=8YFLogxK
U2 - 10.1016/j.ajem.2022.05.011
DO - 10.1016/j.ajem.2022.05.011
M3 - Review article
C2 - 35636042
AN - SCOPUS:85131119222
SN - 0735-6757
VL - 58
SP - 43
EP - 51
JO - American Journal of Emergency Medicine
JF - American Journal of Emergency Medicine
ER -