The WHO (5) and the NIH (6) also released recommendations for the hemodynamic management of COVID-19 patients. The Surviving Sepsis Campaign guidelines were updated for COVID-19 (4). On the other hand, excessive fluid administration may worsen pulmonary edema and arterial hypoxemia. On the one hand, fluid restriction may induce hypovolemia, decrease oxygen delivery to the tissues and promote organ injury. In patients with acute respiratory failure, fluid management is particularly challenging. Indeed, the proportion of ICU patients requiring vasopressor support has been shown to range between 35% and 95% (3).
>Īlthough the proportion of hospitalized patients developing circulatory shock is only around 6% (1), it is much higher in patients admitted in the Intensive Care Unit (ICU) (2). They include hypovolemia because of fever and fluid restriction, systemic vasodilation because of sepsis and deep sedation (in mechanically ventilated patients), LV systolic dysfunction because of circulating cytokines, and RV dysfunction because of mechanical ventilation with positive end-expiratory pressure (PEEP) and/or pulmonary embolism. However, I was surprised they did not discuss the value of echocardiography in the assessment and diagnosis section, nor fluid management in the treatment section.ĬOVID-19 patients have several reasons to become hemodynamically unstable. about the diagnosis and treatment of coronavirus disease 2019 (COVID-19). I read with great interest the review by Wiersinga et al. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.van den Berk, MD (Department of Radiology, Amsterdam UMC), and Bernadette Schurink, MD (Department of Pathology, Amsterdam UMC). D, Pathological manifestations of lung tissue in a patient with severe pneumonia caused by SARS-CoV-2 showing diffuse alveolar damage with edema and fibrine deposition, indicating acute respiratory distress syndrome with early fibrosis (magnification, ×10). C, Pathological manifestations of lung tissue in a patient with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) showing interstitial mononuclear inflammatory infiltrates dominated by lymphocytes (magnification, ×10). B, Transverse thin-section computed tomographic scan of a 76-year-old man, 21 days after symptom onset, showing bilateral and peripheral predominant consolidation, ground-glass with reticulation, and bronchodilatation. A, Transverse thin-section computed tomographic scan of a 76-year-old man, 5 days after symptom onset, showing subpleural ground-glass opacity and consolidation with subpleural sparing.
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