Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease

Patient Guideline Summary

Publication Date: March 1, 2020

Last Updated: March 3, 2023

Objective

This patient summary means to discuss key recommendations from the European Society of Intensive Care Medicine and the Society of Critical Care Medicine for surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease. It is limited to adults 18 years of age and older and should not be used as a reference for children.

Overview

Sepsis is a life-threatening bacterial infection that has spread throughout the body. COVID is a respiratory virus infection like influenza. Severe viral lung infections can weaken the body and render it susceptible to sepsis.

Symptoms include difficult breathing, fever, weakness, confusion, pain.

This patient summary focuses on adults critically ill with COVID.

Diagnosis

If you are critically ill you will have multiple concerns, all of which need constant simultaneous attention for the best outcome.
- Your lungs may need oxygen and assisted ventilation, perhaps even a tube in your airway.
  - A condition called acute respiratory distress syndrome (ARDS) is a potentially fatal lung condition that requires maximum treatment.
- Your heart, blood pressure and circulation may need medicines – maybe even machines – to keep your body’s organs functioning properly, particularly your kidneys and brain.
  - “Shock” describes blood pressure so low it threatens organ function.
- You will need water and nutrition, which may be delivered by mouth, tube or intravenous catheter.
- Additional infections are a major threat when your body is weakened by a serious initial infection.

Treatment

Critically ill patients are treated in intensive care units where maximum resources are available, including:
- For your lungs
  - Oxygen from a nasal tube or face mask
  - Mechanical breathing assistance with a tube in your airway
  - Positive end-expiratory pressure (PEEP) is a treatment that helps keep your airway and lungs open.
- For your heart and circulation
  - Medications to maintain blood pressure
  - Mechanical circulation assistance
- For infections
  - Antibiotics
  - Cortisone sometimes helps your system to heal.
- For your fluid and nutrition
  - An intravenous catheter will supply fluids, electrolytes, glucose and medications.
  - Additional nutrition may be given through a tube if you are unable to eat.
- For your comfort
  - Medications for pain and stress
  - Sedation or anesthesia
  - As much movement and physical activity as possible
Options are chosen based on continuous assessment of your condition and will change as your condition changes.
Some advanced measures may require transfer to a medical center specializing in those treatments.

Abbreviations

ARDS: Acute Respiratory Distress Syndrome
PEEP: Positive End-expiratory Pressure

Source Citation

Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, Oczkowski S, Levy MM, Derde L, Dzierba A, Du B, Aboodi M, Wunsch H, Cecconi M, Koh Y, Chertow DS, Maitland K, Alshamsi F, Belley-Cote E, Greco M, Laundy M, Morgan JS, Kesecioglu J, McGeer A, Mermel L, Mammen MJ, Alexander PE, Arrington A, Centofanti JE, Citerio G, Baw B, Memish ZA, Hammond N, Hayden FG, Evans L, Rhodes A. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020 May;46(5):854-887. doi: 10.1007/s00134-020-06022-5. Epub 2020 Mar 28. PMID: 32222812; PMCID: PMC7101866.

Disclaimer

The information in this patient summary should not be used as a substitute for professional medical care or advice. Contact a health care provider if you have questions about your health.