Covid -19

Management in the ICU

Bernadett Kovacs MD FRCPC
Clinical Lecturer UOttawa
Assistant Professor NOSM
 Covid 19 pneumonia is ARDS

• Gattinoni, L. et al., Intensive Care Med 2020, 46:1099-1102 - error in slide high lung compliance should be high lung
elastane and thus low compliance

• Not new phenomenon. Calfee CS et al., Lancet Respir Med 2014, 2: 611-620

• Phenotype 1 vs Phenotype 2 - hyperinflamatory with higher PEEP showing benefit vs

hypoinflamatory with higher PEEP showing detrimental effects
From: Care for Critically Ill Patients With COVID-19

JAMA. 2020;323(15):1499-1500. doi:10.1001/jama.2020.3633

Low VT ventilation 6ml/kg(IBW)

Higher PEEP ventilation
deep sedation & NMB
Prone ventilation
inhaled NO - no mortality benefit but
improved oxygen with potential
worsened renal function

Figure Legend:

Summary of Caring for Critically Ill Patients With COVID-19

Copyright 2020 American Medical Association. All

Date of download: 5/28/2021
Rights Reserved.
 Recent Data
• REMAP-CAP - IL-6 receptor antagonist compared with standard of care. Tocilizumab 8mg/kg
(max 800mg). Sarilumab 400mg OD. Improved organ support & mortality

• THROMBOSIS

• INSPIRATION - Multicenter randomized trial of interned vs standard DVTp. No difference in

V/A thrombosis, death or ECMO

• ATTACC - therapeutic AC did not improve outcomes

• STEROIDS

• RECOVERY - dex 6 mg po/IV for those receiving oxygen therapy

• REMAP - CAP - 7 days of steroids statistically superior to no steroids for organ free survival

• WHO Rapid Evidence Appraisal for Covid 19 Therapies (REACT) Working group - Meta Analysis
showed decreased all cause mortality