CRITICAL CARE MANAGEMENT

OF PATIENTS WITH COVID-19

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HIPERKOAGULASI HIPERINFLAMASI

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Care of Critically Ill Adult Patients With COVID-19
• INFECTION CONTROL
• HEMODINAMICS
• OXYGENATION AND VENTILATION
• ACUTE KIDNEY INJURY AND RENAL REPLACEMENT THERAPHY
• PHARMACOLOGIC INTERVENTION
• EXTRACORPOREAL MEMBRANE OXYGENATION

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 INFECTION CONTROL
recommendations
• Performing aerosol generating procedur: N95 mask, gloves,gown, eye
protection → in a negative-pressure room
• Endotracheal management by health care provider with extensive
airway management experience
• Using video laringoscope

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 HEMODYNAMIC
recommendations
• Parameters → dynamic parameter, skin temperature, CRT, lactat
levels, if available : arterial catheter
• Acute Fluid Resuscitation → balance crystalloid
• First line Vasopressor → Norepineprin → Vasopressin → epinephrin
• Persistent Hypoperfusion → Dobutamin
• Corticosteroid → refracter shock

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 OXYGENATION AND VENTILATION
recommendations
• Acute Hypoxemic respiratory failure → (closely monitored trial) NIPPV
→ Endotracheal intubation
• Awake prone position
• Mechanical ventilation → Protective Lung Strategy, conservative fluid
strategy, prone position, continuous NMBA, deep sedation
• If no improvement → inhaled pulmonary vasodilators
• Refractory hypoxemia → ECMO

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• ACUTE KIDNEY INJURY
recommendations →CRRT → IRRT→HD
• PHARMACOLOGIC INTERVENTION
1) Antimicrobial
2) Antiviral
3) Corticosteroid
4) Thromboembolic profilaxys
5) IVIG
6) Plasma convalescent
7) Temperature control → Acetaminophen
8) Chloroquine-HydroChloroquin
9) Tocilizumab
10) Ivermectin

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 KEPUSTAKAAN
1. Hajjar LA, Costa IBS da S, Rizk SI, Biselli B, Gomes BR, Bittar CS, et al. Intensive
care management of patients with COVID-19: a practical approach. Vol. 11, Annals of
Intensive Care. Springer Science and Business Media Deutschland GmbH; 2021.
2. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving
Sepsis Campaign: guidelines on the management of critically ill adults with
Coronavirus Disease 2019 (COVID-19). Intensive Care Medicine. 2020 May
1;46(5):854–87.
3. Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of
critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered,
retrospective, observational study. The Lancet Respiratory Medicine. 2020 May
1;8(5):475–81.

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