Coronavirus disease 2019 (COVID-19): update for anesthesiologists and intensivists March 2020 - Der Anesthesist

Bron: 24-03-2020 https://link.springer.com/article/10.1007/s00101-020-00760-3

Aim
Summary of the knowledge about the disease as well as specific aspects and recommendations for this medical discipline.

Summary

• Information on SARS-CoV-2 so far is low evidence studies and therefore is subject to change. 
• Symptoms have large variability, however most common symptoms are fever/elevated temperature and (dry) cough. Classical symptoms of the common cold (sore throat/blocked or runny nose) occur in only around 5-10% of all recorded cases. 5-10% present with primary gastrointestinal symptoms. 
• In most cases, the course of the disease is mild, but around 5% of patients develop severe ARDS.
• Median incubation period is from exposition to first onset symptoms is 4 days, however cases have been reported to have an incubation period of up to 19 to 24 days. A median of 10 days from onset of symptoms to admission to the ICU has been reported, from the time of infection it takes nearly 2 weeks.
• It is necessary to establish structures for providing outpatient care for as many mild cases as possible.
• Pathogen identification is done by PCR, in critically ill patients preferably from the lower respiratory tract.
• NIV therapy or even high-flow oxygen must be assessed critically due to high risk of infection for staff.
• If NIV is nonetheless applied, early intubation is needed in case of failure. 
• Unlike other severe infectious diseases, COVID-19 patients often deteriorate only with a certain delay in the course of disease.
• Avoiding nosocomial COVID infection is crucial, above all by consequent use of personal protective gear.
• Apart from challenges regarding patient care, staff absences and lack of resources can cause considerable problems in hospitals’ operational processes. 
• Structures that provide the care of other medical conditions, e.g. trauma, myocardial infarction or births, need to be maintained at all costs.