Title: Is the Prone Position Helpful During Spontaneous Breathing in Patients With COVID-19?
Publication Date: May 15, 2020
Key Takeaway: Two studies are discussed in this editorial comment:
Study 1: 24 patients with acute hypoxemic respiratory failure and infiltrates on chest CT scans, 6 of 15 patients who tolerated prone position showed a mean (SD) increase in Pao2 of more than 20% from baseline (74  to 95  mm Hg; P = .006) but 3 patients returned to baseline Pao2 after supination.
Study 2: Awake patients with mild and moderate ARDS. Proned in 3 hour sessions, median of 2 NIV sessions. 12 of 15 had improved oxygenation (Pa O 2 :FiO 2 100 to 122) and respiratory rate (28 /min to 24 /min) during and for 1 hour after NIV session. At 14 days, 1 patient was intubated and 1 other died.
Conclusion: many but not all patients with hypoxemic respiratory failure tolerate the prone position while awake, breathing spontaneously or while receiving NIV. Among patients who tolerated a session of prone positioning, improvement in oxygenation and decrease in respiratory rate occurred. The effects were transient, and respiratory rates and oxygenation often returned to baseline after supination.
Title: Development and Validation of a Clinical Risk Score to Predict the Occurrence of Critical Illness in Hospitalized Patients With COVID-19
Publisher: JAMA Internal Medicine
Publication Date: May 12, 2020
Key Takeaway: Study in China, using 1590 patients and a validation cohort of 710 patients, developed and validated a risk score (COVID-GRAM, http://126.96.36.199/) to predict development of critical illness (ICU admission, mechanical ventilation, or death). The 10 risk score predictors included: chest radiography abnormality, age, hemoptysis, dyspnea, unconsciousness, number of comorbidities, cancer history, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, and direct bilirubin. Limitations include need for further validation, especially in other populations.
Title: Impact of Corticosteroid Therapy on Outcomes of Persons With SARS-CoV-2, SARS-CoV, or MERS-CoV Infection: A Systematic Review and Meta-Analysis
Publisher: Leukemia / Nature
Publication Date: May 5, 2020
Key Takeaways: Corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases the conclusions, especially regarding [steroid use in] SARS-CoV-2, confirmation is needed in a randomized clinical trial. The authors suggest caution using corticosteroids in persons with COVID-19.
Editor’s Note: This remains a debated topic, and a non-peer reviewed article recently demonstrated conflicting information.
Title: Treating ARDS in the Era of COVID: A Refined Approach
Publisher: John Hopkins Center for Health Security
Publication Date: April 30, 2020
Key Takeaway: Two phenotypes of Corona-ARDS (CARDS) are described - L & H
Title: Rationale for Prolonged Corticosteroid Treatment in the Acute Respiratory Distress Syndrome Caused by Coronavirus Disease 2019
Publisher: Society for Critical Care Medicine
Publication Date: April 2020
Key Takeaway: International critical care group disagrees with WHO recommendations to save steroids for clinical trials. Authors propose 1mg/kg/day for early mod-severe Corona-ARDS.
Title: Respiratory Support in Novel Coronavirus Disease (COVID-19) Patients
Publisher: American Journal of Tropical Medicine and Hygiene
Publication: April 21, 2020
Title: Management of COVID-19 Respiratory Distress
Publisher: JAMA Network
Publication: April 24, 2020
COVID-19 patients initially tend to retain relatively good compliance despite very poor oxygenation (“Type L” lung disease). This may progress in some patients, either because of disease severity, host response, or suboptimal management, to “Type H” disease characterized by low compliance, higher lung weight, and higher PEEP response.
Title: Covid-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome
Publication: Journal of American Thoracic Society, March 30, 2020
Title: Fast Literature Assessment and Reviews (FLARE) from Massachusetts General Hospital
Key Takeaway: A collaborative effort within the Pulmonary and Critical Care Division to review:
Title: Intensive care management of coronavirus disease 2019 (COVID-19): challenges and recommendations
Publication: Lancet, April 6, 2020
Key Takeaway: Comprehensive intensive care practice guidelines developed by the Asian Critical Care Clinical Trials Group
Title: COVID-19 pneumonia: different respiratory treatment for different phenotypes?
Publication: Intensive Care Medicine, 2020
Key Takeaway: This editorial describes two primary “phenotypes” of Covid-19 related pneumonia:
Title: Swivel-HEPA-ETT (SHE) Bougie and HEPA-ETT (HE) Methods for Safe Intubation While Managing Patients With COVID-19
Publication: Journal of Emergency Medicine, April 15, 2020
Key Takeaway: This article reports on methods to reduce aerosolization during intubation. The authors utilized two methods that incorporated HEPA filters (HEPA-ETT and Swivel-HEPA-ETT) that they believe helped to reduce aerosolization during intubation and allow for confirmation of placement without auscultation.
Title: With ventilators running out, doctors say the machines are overused for Covid-19
Key Takeaway: This is an interesting article by a science reporter about the growing uncertainty of the pulmonary pathophysiology of severe Covid-19 infection and how to best treat it.
Title: High-Dose Intravenous Immunoglobulin as a Therapeutic Option for Deteriorating Patients With Coronavirus Disease 2019
Key Takeaway: This case series reports 3 patients with severe COVID-19 who received high-dose intravenous immunoglobulin (IVIg) with satisfactory recovery. With no definite effective treatments for this novel pathogen, based on these observations high-dose IVIg may be considered for clinical trials or compassionate use in deteriorating patients infected with COVID-19 respiratory failure. March 21, 2020
Updated CDC Webinar slide deck on Covid-19 clinical management
Preliminary Estimates of the Prevalence of Selected Underlying Health Conditions Among Patients with Coronavirus Disease 2019,United States, Feb 12–March 28, 2020
Joint Statement on Multiple Patients Per Ventilator
Care of the Critically Ill and Injured During Pandemics and Disasters
Primer on care of critically-ill patients with Covid-19
Society of Critical Care Medicine Surviving Sepsis Recommendations
Management of Critically Ill Adults with Covid-19