Management of Critical COVID-19 Disease

CRITICAL COVID-19 DISEASE

Includes:

• Respiratory failure

• Septic shock

• Multi-organ dysfunction

May progress toSeptic shock

ICU ADMISSION REQUIRED

i. Airway & Ventilation

• Intubate if airway not protected

• Mechanical ventilation:

  • SpO₂ target > 90%

  • Tidal volume 4–8 mL/kg

  • Plateau pressure < 30 cmH₂O

ii. Oxygenation

• High-flow oxygen → NIV → Mechanical ventilation

• Awake or ventilated proning

iii. Steroids

Same as severe disease

iv. Anticoagulation

Same protocol as severe disease

v. Hemodynamic support

• IV fluids for shock

• Maintain MAP ≥ 65 mmHg

• Vasopressors if needed

vi. Antibiotics

Broad spectrum therapy then culture-guided

vii. Organ support

• Renal support (dialysis if needed)

• Nutrition therapy

• Stress ulcer prophylaxis

• Physiotherapy

Investigational/Adjunct therapies

Used in some settings:

• Remdesivir

• Tocilizumab

• Colchicine

(Used selectively depending on protocol and availability)

CORE PRINCIPLE OF COVID-19 MANAGEMENT

• Mild → symptomatic care

• Moderate → anti-inflammatory therapy

• Severe → oxygen + steroids + anticoagulation

• Critical → organ support + ICU care