Coronavirus-19 (COVID-19) disease is caused by the SARS-CoV-2 virus. The infection is carried by respiratory droplets and close contact. The major organs affected by COVID-19 include the lungs, heart, kidneys, genitals, and liver.
severe COVID-19 cases include respiratory depression and have a high mortality rate. Even healthy individuals may experience severe COVID-19, however, the risk of critical illness and death increases with age.
Severe illness is more common in men than in women. The risk of serious illness is higher among certain ethnic groups, such as Black and Hispanic individuals in the United States. Additional risk factors for the development of severe COVID-19 include heart disease, diabetes mellitus, immunosuppression, and obesity.
What is severe COVID-19?
The most common initial symptoms of COVID-19 include fever, cough, fatigue, headache, muscle aches, and dizziness. Statistically, 5% of patients present with critical illness, while 14% experience severe pain. There are many differences in the duration of symptoms and complications caused by COVID-19. Usually, severe pain begins a week after the onset of symptoms.
Dyspnea (shortness of breath) is the most common symptom of severe COVID-19 and is present in 40% of symptomatic patients. Specifically, severe COVID-19 is diagnosed when the patient experiences:
- A respiratory rate of not less than 30 breaths per minute
- A blood oxygen saturation of 93% or less
- Oxygenation index of 300mmHg
- Contained more than 50% of the lung field in lung imaging tests
Dyspnea is often accompanied by hypoxemia (low blood oxygen). Many patients with severe COVID-19 also have progressive respiratory failure, lymphopenia, thromboembolic complications, and diseases of the central or peripheral nervous system.
Severe COVID-19 can lead to severe damage to the heart, kidneys, and liver. Other complications include shock, cardiac arrhythmias, rhabdomyolysis (rapid rupture of damaged skeletal muscle), and coagulopathy (impaired ability to form blood vessels). The leading cause of death in patients with COVID-19 is respiratory failure, which is why the primary treatment is respiratory support.
How is severe COVID-19 treated?
Identify COVID-19 used:
- Clinical history of patients
- Detection of SARS-CoV-2 RNA in respiratory discharges
- The discovery of the two common uses of chest radiographs
After diagnosis, the first step for the treatment of severe COVID-19 is hospitalization for careful monitoring. Patients were monitored in the intensive care unit through direct observation and pulse oximetry (a non-invasive test that measures oxygen saturation levels). Oxygen supplementation using a nasal cannula or Venturi mask is essential to maintain the oxygen saturation of hemoglobin at 90-96%.
Methods currently used to treat COVID-19 include endotracheal intubation, extubation, bronchoscopy, airway suctioning, nebulization of medication, use of high-flow nasal cannulae, non-invasive ventilation, and manual ventilation with a bag-mask. device. Patients treated for severe COVID-19 require appropriate nutrition and care to avoid further harm.
In accordance with current guidelines, clinicians should wear appropriate personal protective equipment (PPE), including gloves, gown, N95 mask, and eye protection, when having patients with COVID-19. . If possible, patients should also wear surgical masks to limit the spread of infectious droplets.
Deciding when a patient with severe COVID-19 should receive endotracheal intubation is an important part of care. Endotracheal intubation is performed by a skilled operator to insert a quick plastic tube into the patient’s trachea to maintain an open and safe passageway. The trachea (also called a windpipe) is a large tube that allows air to pass through.
Patients require ventilation to protect the lungs after intubation, with a spinal pressure of 30cm of water and infiltration of the intubes based on the patient’s height If patients do not require intubation but are hypoxemic, a high- nasal canal flow to improve oxygenation.
Medications, including sedatives and analgesics, are frequently used to prevent pain, discomfort, and dyspnea in patients with severe COVID-19. Dexamethasone is a steroid that is now considered standard of care in patients. This drug reduced the mortality rate in this group of patients in need of oxygen, especially those who received oxygen through mechanical ventilation. A large clinical trial showed that dexamethasone resulted in a 17% reduction in mortality in patients hospitalized with COVID-19 requiring additional oxygen.
Even if remdesivir is approved by the Food and Drug Administration (FDA) for the treatment of Covid-19 in hospitalized patients, much data is needed to understand its function in the treatment of severe COVID-19. Remdesivir seems to have an antiviral mechanism of action because it has been shown to reduce the time it takes for patients to reach clinical recovery. The combined use of dexamethasone and remdesivir has been used more clinically, although its efficacy requires further research from clinical trials. Other antiviral drugs have been tried to be used against COVID-19, including lopinavir and ritonavir.
Patients with COVID-19 may simply be discharged from the intensive care unit and transferred to a department for treatment once specific criteria are met. These criteria include:
- A disappearance of fever for at least three days
- Primary improvement of respiratory symptoms
- Chest scan showing injury reduction
- There is no danger of damaging the life of the main organs
To prevent the high risk of complications from severe COVID-19, it is important that all infection prevention instructions are followed and care objectives for each patient are promptly established.
Berlin, D., Gulick, R., and Martinez, F. (2020). Severe Covid-19. The New England Journal of Medicine, 383 (25), 2451-2460. Retrieved from: https://www.nejm.org/doi/full/10.1056/NEJMcp2009575?query=featured_home
Xie, P., et al. (2020). Severe Covid-19: a review of recent developments with a view to the future. Frontiers of Public Health, 8, 189. Retrieved from: https://doi.org/10.3389/fpubh.2020.00189
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