Successful management of seven cases of critical COVID-19 with early noninvasive-invasive sequential ventilation algorit
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CASE REPORT
Successful management of seven cases of critical COVID-19 with early noninvasive–invasive sequential ventilation algorithm and bundle pharmacotherapy Mian Peng1, Xueyan Liu ( Weixiong Zhong1
✉)2, Jinxiu Li3, Di Ren4, Yongfeng Liu5, Xi Meng3, Yansi Lyu6, Ronglin Chen5, Baojun Yu7,
1
Department of Intensive Care Unit, The Third Affiliated Hospital of Shenzhen University, Shenzhen 518001, China; 2Department of Intensive Care Unit, Shenzhen People’s Hospital, First Affiliated Hospital of Southern University of Science and Technology, The Second Affiliated Hospital of Jinan University, Shenzhen 518020, China; 3Department of Intensive Care Unit, The Third People’s Hospital of Shenzhen, Shenzhen 518112, China; 4Department of Intensive Care Unit, The Second People’s Hospital of Shenzhen, Shenzhen 518035, China; 5 Department of Intensive Care Unit, Shenzhen Longgang Central Hospital, Shenzhen 518116, China; 6Department of Dermatology, Shenzhen University General Hospital, Shenzhen 518055, China; 7Department of Intensive Care Unit, Shenzhen Baoan District People’s Hospital, Shenzhen 518101, China
© Higher Education Press 2020
Abstract We report the clinical and laboratory findings and successful management of seven patients with critical coronavirus disease 2019 (COVID-19) requiring mechanical ventilation (MV). The patients were diagnosed based on epidemiological history, clinical manifestations, and nucleic acid testing. Upon diagnosis with COVID-19 of critical severity, the patients were admitted to the intensive care unit, where they received early noninvasive–invasive sequential ventilation, early prone positioning, and bundle pharmacotherapy regimen, which consists of antiviral, anti-inflammation, immune-enhancing, and complication-prophylaxis medicines. The patients presented fever (n = 7, 100%), dry cough (n = 3, 42.9%), weakness (n = 2, 28.6%), chest tightness (n = 1, 14.3%), and/or muscle pain (n = 1, 14.3%). All patients had normal or lower than normal white blood cell count/ lymphocyte count, and chest computed tomography scans showed bilateral patchy shadows or ground glass opacity in the lungs. Nucleic acid testing confirmed COVID-19 in all seven patients. The median MV duration and intensive care unit stay were 9.9 days (interquartile range, 6.5–14.6 days; range, 5–17 days) and 12.9 days (interquartile range, 9.7–17.6 days; range, 7–19 days), respectively. All seven patients were extubated, weaned off MV, transferred to the common ward, and discharged as of the writing of this report. Thus, we concluded that good outcomes for patients with critical COVID-19 can be achieved with early noninvasive–invasive sequential ventilation and bundle pharmacotherapy. Keywords
COVID-19; noninvasive–invasive sequential ventilation; bundle pharmacotherapy
Introduction The transmission of pathogens from animals to humans and resultant zoonotic infectious diseases have been associated with several major global outbreaks and constitute global public health burden. Generally, coronaviruses (CoVs) are enveloped RNA vi
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