Successful management of seven cases of critical COVID-19 with early noninvasive–invasive sequential ventilation algorithm and bundle pharmacotherapy

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

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Acknowledgements

We acknowledge the writing guidance provided by Prof. Kunmei Ji and the training camp for medical research held by Shenzhen Medical Association and Huada. We are grateful to the physicians and nurses of the Third People’s Hospital of Shenzhen who participated in the clinical examinations and sample collection.

Compliance with ethics guidelines

Mian Peng, Xueyan Liu, Jinxiu Li, Di Ren, Yongfeng Liu, Xi Meng, Yansi Lyu, Ronglin Chen, Baojun Yu, and Weixiong Zhong declare no conflict of interest. Written informed consent was obtained from all the patients.

RIGHTS & PERMISSIONS

2020 Higher Education Press