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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. Jul 9, 2021; 10(4): 81-101
Published online Jul 9, 2021. doi: 10.5492/wjccm.v10.i4.81
What we learned in the past year in managing our COVID-19 patients in intensive care units?
Jain Nitesh, Rahul Kashyap, Salim R Surani
Jain Nitesh, Department of Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Rahul Kashyap, Department of Anesthesiology, Mayo Clinic, Rochester, MN 55905, United States
Salim R Surani, Department of Medicine, Texas A&M University, Corpus Christi, TX 78404, United States
Author contributions: Surani SR and Kashyap R have contributed to the idea, review of data and manuscript; Nitesh J has also been involved in data search and initial write-up.
Conflict-of-interest statement: There are nothing to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim R Surani, FCCP, MD, Professor, Department of Medicine, Texas A&M University, 701 Ayers, Corpus Christi, TX 78404, United States. srsurani@gmail.com
Received: February 16, 2021
Peer-review started: February 16, 2021
First decision: March 31, 2021
Revised: April 7, 2021
Accepted: May 17, 2021
Article in press: May 17, 2021
Published online: July 9, 2021
Processing time: 140 Days and 23 Hours
Abstract

Coronavirus disease 2019 is a pandemic, was first recognized at Wuhan province, China in December 2019. The disease spread quickly across the globe, spreading stealthily from human to human through both symptomatic and asymptomatic individuals. A multisystem disease which appears to primarily spread via bio aerosols, it has exhibited a wide clinical spectrum involving multiple organ systems with the respiratory system pathology being the prime cause of morbidity and mortality. Initially unleashing a huge destructive trail at Wuhan China, Lombardy Italy and New York City, it has now spread to all parts of the globe and has actively thrived and mutated into new forms. Health care systems and Governments responded initially with panic, with containment measures giving way to mitigation strategies. The global medical and scientific community has come together and responded to this huge challenge. Professional medical societies quickly laid out “expert” guidelines which were conservative in their approach. Many drugs were re formulated and tested quickly with the help of national and international collaborative groups, helping carve out effective treatment strategies and help build a good scientific foundation for evidence-based medicine. Out of the darkness of chaos, we now have an orderly approach to manage this disease both from a public health preventive and therapeutic standpoint. With preventive measures such as masking and social distancing to the development of highly effective and potent vaccines, the public health success of such measures has been tempered by behavioral responses and resource mobilization. From a therapy standpoint, we now have drugs that were promising but now proven ineffective, and those that are effective when given early during viral pathogenesis or later when immune dysregulation has established, and the goal is to help reign in the destructive cascade. It has been a fascinating journey for mankind and our work here recapitulates the evolution of various aspects of critical care and other inpatient practices which continue to evolve.

Keywords: COVID-19; Respiratory support; Renal replacement therapy; Extracorporeal membrane oxygenator; Medications; Therapeutics

Core Tip: Severe acute respiratory syndrome coronavirus 2 transmission and the inpatient therapeutic management of coronavirus disease 2019 has been subject of immense research in the past one year. Our knowledge and understanding of the virus and the treatment of the disease continue to evolve. We attempt to summarize the progress made in a concise but comprehensive manner along with our insights into future directions.