As the COVID-19 pandemic continues to rage around the world, there have been more than 600 million confirmed infections and over 6.5 million deaths to date. Early identification of patients who may become severely ill is essential to reduce mortality. In addition, when patients become critically ill, they need timely and effective supportive treatment, as well as rapid and safe transfer to intensive care units (ICU).
When a patient develops respiratory distress, hypoxia (low oxygen levels in the blood), or shock, oxygen therapy must be administered. At the beginning, oxygen should be supplied at a rate of five liters per minute to help the blood oxygen value of SpO2 rise above 90 percent at the very least. For pregnant women, SpO2 needs to be in the 92 to 95 percent range.
ICU for COVID patients must be equipped with oxygen supply devices such as nasal cannula, simple oxygen mask, or non-circulatory breathing mask. A pulse oximeter should also be equipped to monitor oxygen levels at all times.
If the patient is not in shock, infusion therapy should be applied with caution. This is because too much fluid infusion will decrease oxygenation, especially if the respiratory equipment is insufficient.
Severely ill patients also need to be given antibiotics, first on an empirical basis. Thereafter, doctors should come up with an optimized antibiotics plan based on the results.
In case of respiratory failure or sepsis, treatment with supportive organ perfusion can be applied.
If a patient needs intubation treatment, precautions should be taken to prevent doctor-patient infection, because intubation generates a large number of viral droplets, and the doctor is in close contact with the patient. Medical staff must wear complete protective equipment before performing the procedure.
The incubator must be technically proficient and the intubation can only be applied inside a negative pressure isolation room. If the patient’s vital signs are unstable and in respiratory failure, intubation treatment must be performed immediately, and appropriate drugs can be used during intubation.
Steroids are generally not used for the treatment of COVID-19, unless there are special circumstances. This aspect is very different from the treatment of SARS.
When the blood pressure of a patient requires vasopressors to maintain mean arterial pressure ≥ 65mmHg, lactate value ≥ 2 mmol/L, and there are no blood loss problems, the patient is already at the stage of septic shock.
In this case, an isotonic crystalloid solution should be infused. In a septic shock state, hypotonic crystalloids, starches, or gelatins should not be infused; and if the blood pressure is still low after the infusion, the infusion should be stopped to avoid volume overload.
Treating COVID-19 patients is like fighting a war. It is best to have well-trained medical staff take care of severely or critically ill patients in critical care areas. This will not only ensure the best care for patients but also the best protection for medical staff.
Dr. Teng Cheng-Liang, is a Chinese and Western medicine practitioner with more than 20 years of professional medical experience. He is the Superintendent of Chi Teh Medical Clinic & Cheng-Liang Medical Clinic in Taipei, Taiwan. He graduated from the College of Medicine at Taipei Medical University and completed his Doctoral Degree in Traditional Chinese Medicine at the Nanjing University of Chinese Medicine.