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Maslove DM, Sibley S, Boyd JG, et al. Complications of critical COVID-19: Diagnostic and therapeutic considerations for the mechanically ventilated patient. Chest. 2021;doi: 10.1016/j.chest.2021.10.011.
Maslove, D. M., Sibley, S., Boyd, J. G., Goligher, E. C., Munshi, L., Bogoch, I. I., & Rochwerg, B. (2021). Complications of critical COVID-19: Diagnostic and therapeutic considerations for the mechanically ventilated patient. Chest, . https://doi.org/10.1016/j.chest.2021.10.011
Maslove, David M, et al. "Complications of critical COVID-19: Diagnostic and therapeutic considerations for the mechanically ventilated patient." Chest vol. (2021). doi: https://doi.org/10.1016/j.chest.2021.10.011
Maslove DM, Sibley S, Boyd JG, Goligher EC, Munshi L, Bogoch II, Rochwerg B. Complications of critical COVID-19: Diagnostic and therapeutic considerations for the mechanically ventilated patient. Chest. 2021 Oct 13; doi: 10.1016/j.chest.2021.10.011. Epub 2021 Oct 13. PMID: 34655568; PMCID: PMC8511547.
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Chest. 2021 Oct 13; doi: 10.1016/j.chest.2021.10.011. Epub 2021 Oct 13.

Complications of critical COVID-19: Diagnostic and therapeutic considerations for the mechanically ventilated patient.

Chest

David M Maslove, Stephanie Sibley, J Gordon Boyd, Ewan C Goligher, Laveena Munshi, Isaac I Bogoch, Bram Rochwerg

Affiliations

  1. Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre, Kingston, Ontario, Canada. Electronic address: [email protected].
  2. Department of Critical Care Medicine, Queen's University, Kingston, Ontario, Canada; Kingston Health Sciences Centre, Kingston, Ontario, Canada.
  3. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada.
  4. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada.
  5. University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
  6. Department of Medicine, McMaster University, Hamilton, Ontario, Canada; Juravinski Hospital, Hamilton, Ontario, Canada.

PMID: 34655568 PMCID: PMC8511547 DOI: 10.1016/j.chest.2021.10.011

Abstract

Patients admitted to the intensive care unit with critical COVID-19 often require prolonged periods of mechanical ventilation. Difficulty weaning, lack of progress, and clinical deterioration are commonly encountered. These conditions should prompt a thorough evaluation for persistent or untreated manifestations of COVID-19, as well as complications from COVID-19 and its various treatments. Inflammation may persist and lead to fibroproliferative changes in the lungs. Infectious complications may arise including bacterial superinfection in the earlier stages of disease. Use of immunosuppressants may lead to the dissemination of latent infections, and to opportunistic infections. Venous thromboembolic disease is common, as are certain neurologic manifestations of COVID-19 including delirium and stroke. High levels of ventilatory support may lead to ventilator-induced injury to the lungs and diaphragm. We present diagnostic and therapeutic considerations for the mechanically ventilated COVID-19 patient who shows persistent or worsening signs of critical illness, and we offer an approach to managing this complex but common scenario.

Copyright © 2021. Published by Elsevier Inc.

Keywords: ARDS; COVID-19; complications; critical care; intensive care unit; mechanical ventilation

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