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Critical care management of adults with community-acquired severe respiratory viral infection.
Intensive Care Med. 2020 02; 46(2):315-328.IC

Abstract

With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17-53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of influenza; data suggest that early use is associated with reduced mortality in critically ill patients with influenza. At present, there are no antiviral therapies of proven efficacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specific for critically ill patients with severe RVI. There is a need for more pragmatic and efficient designs to test different therapeutics both individually and in combination.

Authors+Show Affiliations

College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Arabi@ngha.med.sa. King Abdullah International Medical Research Center, Riyadh, Saudi Arabia. Arabi@ngha.med.sa. Intensive Care Department, King Abdulaziz Medical City, P.O. Box 22490, Riyadh, 11426, Saudi Arabia. Arabi@ngha.med.sa.Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada. Department of Critical Care Medicine, Sunnybrook Hospital, Toronto, Canada. Department of Medicine, Sunnybrook Hospital, Toronto, Canada.Department of Medicine, Division of Infectious Diseases and International Health, University of Virginia School of Medicine, Charlottesville, VA, USA.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32040667

Citation

Arabi, Yaseen M., et al. "Critical Care Management of Adults With Community-acquired Severe Respiratory Viral Infection." Intensive Care Medicine, vol. 46, no. 2, 2020, pp. 315-328.
Arabi YM, Fowler R, Hayden FG. Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Med. 2020;46(2):315-328.
Arabi, Y. M., Fowler, R., & Hayden, F. G. (2020). Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Medicine, 46(2), 315-328. https://doi.org/10.1007/s00134-020-05943-5
Arabi YM, Fowler R, Hayden FG. Critical Care Management of Adults With Community-acquired Severe Respiratory Viral Infection. Intensive Care Med. 2020;46(2):315-328. PubMed PMID: 32040667.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Critical care management of adults with community-acquired severe respiratory viral infection. AU - Arabi,Yaseen M, AU - Fowler,Robert, AU - Hayden,Frederick G, Y1 - 2020/02/10/ PY - 2019/10/20/received PY - 2020/01/16/accepted PY - 2020/2/11/pubmed PY - 2020/3/19/medline PY - 2020/2/11/entrez KW - Acute respiratory distress syndrome KW - Antiviral therapy KW - Coronavirus KW - Influenza KW - Neuraminidase inhibitor SP - 315 EP - 328 JF - Intensive care medicine JO - Intensive Care Med VL - 46 IS - 2 N2 - With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17-53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identified. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of influenza; data suggest that early use is associated with reduced mortality in critically ill patients with influenza. At present, there are no antiviral therapies of proven efficacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory effects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specific for critically ill patients with severe RVI. There is a need for more pragmatic and efficient designs to test different therapeutics both individually and in combination. SN - 1432-1238 UR - https://www.unboundmedicine.com/medline/citation/32040667/Critical_care_management_of_adults_with_community_acquired_severe_respiratory_viral_infection_ DB - PRIME DP - Unbound Medicine ER -