[Skip to Content]
[Skip to Content Landing]

Management of Critically Ill Adults With COVID-19

Educational Objective
To understand the latest concepts about critical care of COVID-19 patients
1 Credit CME

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of COVID-19, a pandemic that has affected more than 400 000 individuals and caused nearly 20 000 deaths as of late March 2020. Approximately 5% to 10% of patients require intensive care unit (ICU) admission and mechanical ventilation.1

The Surviving Sepsis Campaign (SSC) has previously published a series of guidelines for sepsis and septic shock. Based on this experience, experts were recruited to write guidelines on the management of COVID-19 in critically ill adults. These guidelines were authored by 36 experts from 12 countries (Table).2 Recommendations were developed based on limited direct evidence with COVID-19 cases and indirect evidence derived from previous pandemics such as Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and other coronavirus infections. Overall, the panel issued 54 statements: 4 best practice statements, 9 strong recommendations, and 35 weak recommendations. (No recommendations were made for the remaining 6 topics.)

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

Article Information

Corresponding Author: Jason T. Poston, MD, University of Chicago, 850 E 58th St, Chicago, IL 60615 (Jason.Poston@uchospitals.edu).

Published Online: March 26, 2020. doi:10.1001/jama.2020.4914

Correction: This article was corrected on April 3, 2020, to include all of the related resources and relevant publications.

Conflict of Interest Disclosures: Dr Patel reports receiving grants from Parker B. Francis Career Development award and from NIH/NHLBI T32 HL007605 Research Training in Respiratory Biology. Dr Poston receiving honoraria for the CHEST Critical Care Board Review Course. Dr Davis reported no disclosures.

References
1.
Wu  Z , McGoogan  JM .  Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.   JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648PubMedGoogle Scholar
2.
Surviving Sepsis Campaign. COVID-19 Guidelines. Published March 20, 2020. https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19
3.
Radonovich  LJ  Jr , Simberkoff  MS , Bessesen  MT ,  et al; ResPECT investigators.  N95 respirators vs medical masks for preventing influenza among health care personnel.   JAMA. 2019;322(9):824-833. doi:10.1001/jama.2019.11645PubMedGoogle ScholarCrossref
4.
Bednarczyk  JM , Fridfinnson  JA , Kumar  A ,  et al.  Incorporating dynamic assessment of fluid responsiveness into goal-directed therapy: a systematic review and meta-analysis.   Crit Care Med. 2017;45(9):1538-1545. doi:10.1097/CCM.0000000000002554PubMedGoogle ScholarCrossref
5.
Bentzer  P , Griesdale  DE , Boyd  J , MacLean  K , Sirounis  D , Ayas  NT .  Will this hemodynamically unstable patient respond to a bolus of intravenous fluids?   JAMA. 2016;316(12):1298-1309. doi:10.1001/jama.2016.12310PubMedGoogle ScholarCrossref
6.
Wang  Y , Jiang  W , He  Q ,  et al Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China. medRxiv. Preprint posted March 12, 2020. doi:10.1101/2020.03.06.20032342v1
7.
Lansbury  L , Rodrigo  C , Leonardi-Bee  J , Nguyen-Van-Tam  J , Lim  WS .  Corticosteroids as adjunctive therapy in the treatment of influenza.   Cochrane Database Syst Rev. 2019;2:CD010406.PubMedGoogle Scholar
8.
Frat  JP , Thille  AW , Mercat  A ,  et al; FLORALI Study Group; REVA Network.  High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure.   N Engl J Med. 2015;372(23):2185-2196. doi:10.1056/NEJMoa1503326PubMedGoogle ScholarCrossref
9.
Patel  BK , Wolfe  KS , Pohlman  AS , Hall  JB , Kress  JP .  Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial.   JAMA. 2016;315(22):2435-2441. doi:10.1001/jama.2016.6338PubMedGoogle ScholarCrossref
10.
SIAARTI. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional resource-limited circumstances. Published March 16, 2020. Accessed March 23, 2020. http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
If you are not a JN Learning subscriber, you can either:
Subscribe to JN Learning for one year
Buy this activity
jn-learning_Modal_LoginSubscribe_Purchase
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
jn-learning_Modal_SaveSearch_NoAccess_Purchase
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close