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Infection with the severe acute respiratory syndrome coronavirus- 2 (SARS-CoV-2) was first identified in December 2019 and has since become a worldwide pandemic, challenging and sometimes overwhelming healthcare systems as well as causing more than a million deaths thus far. In just 10 months, over 80,000 indexed publications have appeared that reference SARS-CoV-2 and the associated Coronavirus disease 2019 (COVID-19). In this article, we highlight 20 papers that are of particular relevance to the critical care clinician. The papers are divided into four broad topics: manifestations of severe COVID- 19 disease, pharmacological therapy for COVID-19, ventilatory support for COVID-19 acute respiratory distress syndrome (ARDS), and healthcare system and worker stress. This list is not designed to be comprehensive but rather to give the reader an overview of important early papers and their findings. info:eu-repo/semantics/publishedVersion

Sepsis is a life-threatening condition characterized by one or more organ dysfunctions due to a dysregulated host response to infection [1] or, in certain cases, due to direct pathogen effects. Sepsis is not only associated with bacterial or fungal infections but also with any other infection such as viral disease, protozoal (e.g., malaria), or tropical infections. Although the literature suggests that sepsis is predominantly a healthcare issue in resource-rich countries, the global burden of acute infections is highest in resource-limited areas [2]. Successful sepsis management relies on various components of which early recognition is essential. Evidence and recommendations for sepsis recognition are mainly based on research performed in resource-rich settings [3]. However, resource-rich and -limited countries differ in healthcare accessibility [4] and infectious disease epidemiology [5–7]. It is therefore unreasonable to directly translate evidence between these settings. The Global Intensive Care working group of the European Society of Intensive Care Medicine together with the Mahidol-Oxford Research Unit formed an international team of physicians to revise existent recommendations for sepsis management in resource-limited settings [8]. In this manuscript, we summarize recommendations on sepsis recognition. A detailed description of the guideline team, conflicts of interest, methods, rationales, and references is given in the Online supplement.

In this chapter we discuss recommendations on the identification of patients with acute respiratory distress syndrome (ARDS), indications for mechanical ventilation, and strategies for lung-protective ventilation in resource-limited settings. Where blood gas analyzers are unavailable, it can be replaced by the plethysmographic oxygen saturation/fractional inspirational oxygen concentration (SpO2/FiO2) gradient. Bedside lung ultrasound is a valuable diagnostic tool assessing pulmonary edema and other pathologies. A number of recommendations for safe and lung-protective mechanical ventilation in patients with sepsis and respiratory failure are provided. However, many of these have not been trialed specifically in resource-limited settings. These recommendations include an elevated head-of-bed position and a minimum level of positive end-expiratory pressure (PEEP) of 5 cm H2O only to be in patients with moderate or severe ARDS. In addition, low FiO2 and low oxygenation goals are suggested, using PEEP/FiO2 tables. Recruitment maneuvers are indicated in refractory hypoxia, but require experienced staff. Low tidal volumes (5–7 ml/kg predicted body weight, avoiding >10 ml/kg) are recommended and if at all possible in combination with end-tidal carbon dioxide (CO2) monitoring for recognition of dislodgement of the endotracheal tube and under- or overventilation. “Volume-controlled” modes could be safer than “pressure-controlled” modes, and we recommend to check regularly whether a patient tolerates a “support” mode; we also suggest to perform spontaneous breathing trials to timely identify patients who are ready for extubation, but also to plan extubating patients when sufficient staff is around to guarantee safe re-intubation.

The emergence of the Ebola virus disease (EVD) outbreak in West Africa threatens regional and global public health security. This epidemic, first announced in March 2014 in Guinea Conakry, has grown dramatically since June 2014 with an extension into Liberia and Sierra Leone. Nigeria, Mali, and Democratic Republic of the Congo were also transiently affected. It was declared to be a public health emergency of international concern by the World Health Organization (WHO) on 8 August 2014. On 21 January 2015, a cumulative total of more than 21,800 cases was reported by the WHO [1], with a case fatality rate (CFR) of between 57 and 59 % among hospitalized patients. A total of 828 healthcare workers (HCWs) have been infected with the Ebola virus since the beginning of the epidemic, with a CFR of 60 %. Some Western countries have also reported imported cases: six patients in the USA, Spain and UK, including one death (CFR of 16.7 %). Direct contact with infected bodily fluids—usually feces, vomit, or blood—is necessary for transmission. Once the Ebola virus is suspected, based on national versions of WHO’s case definition recommendations [2], specific laboratory tests can confirm or disprove diagnoses in a few hours, but for this, the patient has to be transported to a specialized center with specific management conditions [3]. In this article, the authors compared procedures for the transport of Ebola patients in their respective countries (USA, UK, and France) to identify common principles.