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Published on: September 24, 2020
Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations
Jason Phua1, Li Weng2, Lowell Ling3
1Fast and Chronic Programmes, Alexandra Hospital, National University Health System, Singapore; Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore.
Insights
The intensive care unit (ICU) community must prepare for the COVID-19 pandemic by streamlining workflows, managing critical care capacity, and addressing research questions. Collaboration is vital for the survival of critically ill patients during this global health crisis.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Public Health
Background:
- The global spread of coronavirus disease 2019 (COVID-19) presents significant challenges to intensive care units (ICUs).
- Nosocomial transmission poses risks to patients with COVID-19, healthcare workers, and other patients.
- Effective management of acute respiratory failure and hemodynamic instability is crucial for patient outcomes.
Purpose of the Study:
- To outline essential preparations for ICUs facing the COVID-19 pandemic.
- To emphasize the importance of workflow streamlining, resource management, and research.
- To highlight the need for multi-level collaboration in critical care.
Main Methods:
- Review of critical care management strategies during pandemics.
- Analysis of workflow optimization for diagnosis, isolation, and infection prevention.
- Discussion of resource allocation, including bed capacity and staffing.
Main Results:
- Streamlining workflows for diagnosis, isolation, clinical management, and infection prevention is essential.
- Preparation requires increased critical care bed capacity, infrastructure, supplies, and staff management.
- Critical care triage may be necessary to ration scarce resources.
- Further research into repurposed and experimental therapies is needed.
Conclusions:
- The ICU community must proactively prepare for the COVID-19 pandemic.
- A comprehensive approach involving infrastructure, staffing, and resource management is required.
- International collaboration and continued research are paramount for improving survival rates for critically ill patients.
Abstract:
As coronavirus disease 2019 (COVID-19) spreads across the world, the intensive care unit (ICU) community must prepare for the challenges associated with this pandemic. Streamlining of workflows for rapid diagnosis and isolation, clinical management, and infection prevention will matter not only to patients with COVID-19, but also to health-care workers and other patients who are at risk from nosocomial transmission. Management of acute respiratory failure and haemodynamics is key. ICU practitioners, hospital administrators, governments, and policy makers must prepare for a substantial increase in critical care bed capacity, with a focus not just on infrastructure and supplies, but also on staff management. Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international level offers the best chance of survival for the critically ill.
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