Evidence-Based Management of the Critically Ill Adult With SARS-CoV-2 Infection

J Intensive Care Med. 2021 Jan;36(1):18-41. doi: 10.1177/0885066620969132. Epub 2020 Oct 28.


Human infection by the novel viral pathogen SARS-CoV-2 results in a clinical syndrome termed Coronavirus Disease 2019 (COVID-19). Although the majority of COVID-19 cases are self-limiting, a substantial minority of patients develop disease severe enough to require intensive care. Features of critical illness associated with COVID-19 include hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), shock, and multiple organ dysfunction syndrome (MODS). In most (but not all) respects critically ill patients with COVID-19 resemble critically ill patients with ARDS due to other causes and are optimally managed with standard, evidence-based critical care protocols. However, there is naturally an intense interest in developing specific therapies for severe COVID-19. Here we synthesize the rapidly expanding literature around the pathophysiology, clinical presentation, and management of COVID-19 with a focus on those points most relevant for intensivists tasked with caring for these patients. We specifically highlight evidence-based approaches that we believe should guide the identification, triage, respiratory support, and general ICU care of critically ill patients infected with SARS-CoV-2. In addition, in light of the pressing need and growing enthusiasm for targeted COVID-19 therapies, we review the biological basis, plausibility, and clinical evidence underlying these novel treatment approaches.

Keywords: COVID-19; SARS-CoV-2; acute respiratory distress syndrome (ARDS); acute respiratory failure; coronavirus; critical care; hypoxemia; pandemic.

Publication types

  • Review

MeSH terms

  • Adult
  • COVID-19 / complications
  • COVID-19 / physiopathology
  • COVID-19 / therapy*
  • Critical Care / methods*
  • Critical Illness / therapy*
  • Evidence-Based Practice / methods
  • Humans
  • Respiratory Insufficiency / etiology
  • Respiratory Insufficiency / therapy