key: cord-0713284-ruhabo55
authors: Melesse, Debas Yaregal; Chekol, Wubie Birlie
title: The management of patients with coronavirus disease 2019 in intensive care unit (ICU) in low income countries: A review article
date: 2021-05-23
journal: Clin Nutr Open Sci
DOI: 10.1016/j.nutos.2021.05.001
sha: cc562ddecde5cc51a21ce129e441fb79c515c3e4
doc_id: 713284
cord_uid: ruhabo55

Background The novel coronavirus, severe acute respiratory syndrome-CoV-2 (SARS-CoV2)- causing coronavirus disease 19 (COVID-19), outbreak as a world health problem and was declared as a pandemic disease by the world health organization (WHO) in March 2020. Many serious findings have been observed among victims with sever acute respiratory syndrome-CoV-2. Methods This review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) protocol. Search engines like PubMed and PMC through HINARI, Cochrane database, Google Scholar were used to get information about the current evidences on management of coronavirus disease 2019 (COVID-19) in intensive care unit (ICU). Discussion Mortality with COVID 19 is associated with geriatric population, the presence comorbidities like hypertension, diabetes mellitus, cardiovascular disease, chronic lung disease, and cancer, acute respiratory failure, higher d-dimer and C-reactive protein concentrations, lower lymphocyte counts, and secondary infections. Conclusion The international recommendations on nutrition in the ICU should be followed. Some specific issues about the nutrition of the COVID-19 patients in the ICU should be emphasized. Universal infection prevention precautions (hand hygiene and use of personal protection equipment (PPE)) are invaluable during nursing of COVID 19 patients at ICU.

Many serious findings have been observed among victims with sever acute respiratory 1 syndrome-CoV-2 and admitted to intensive care unit. Patients at intensive care unit have higher 2 neutrophil and white blood cell counts and higher levels of D-dimer, creatine and creatine kinase. 3 The median time from symptom onset to ICU admission has been reported to be 10 days. The 4 median Glasgow Coma Scale (GCS), Acute Physiology and Chronic Health Evaluation 5 (APACHE) II, and Sequential Organ Failure Assessment (SOFA) scores on the day of ICU 6 admission have been calculated and appeared to be: the median GCS score is 15 (IQR, 9-15), 7 SOFA score is 5 (IQR, [3] [4] [5] [6] , and APACHE II is 17 (IQR, [10] [11] [12] [13] [14] [15] [16] [17] [18] [19] [20] [21] [22] (3) . Patients with COVID-19 8 can progress from asymptomatic or mild illness to acute respiratory failure or multiorgan failure 9 that need intubation and intensive care management. 10 Healthcare workers (HCWs) and especially Anesthesiologists/ Anesthetists are at the frontline 11 of this pandemic diseases and they need updated evidences about staff safety and patient 12 management at ICU (4) . Airway management of patients with COVID-19 is high risk for the 13 transmission of the virus to care givers (5) . The novel severe acute respiratory syndrome 14 coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 15 2019 (COVID- 19) , affecting millions of people around the world (6). Since the 2019 novel 16 coronavirus disease (COVID-19) outbreak originated from Wuhan, Hubei Province, China, at the 17 end of 2019, it has become a health service challenge to the world. 18 Among people infected with the novel coronavirus (2019-nCoV), the intensive management of 19 the critically ill patients in intensive care unit (ICU) needs substantial medical resource and 20 adequate drugs, adjunctive agents, respiratory supportive strategies as well as circulation 21 management, multiple organ function monitoring and appropriate nutritional supplementation 22 J o u r n a l P r e -p r o o f 6 analysis, systematic review of RCTs, Evidence based guidelines) 1b (Systematic review of one 1 RCT), 1c (RCTs), 2a (Systematic review of cohort or case control studies) and 3a (non-analytical 2 studies like case report and case series, clinical audits, commentaries) (Table 1) . Finally, 3 conclusion had been drawn based on the level of evidences. This review article has been 4 registered with unique identification number (UIN) of reviewregistry976. 

Since the emerging of COVID 3 World Health Organization suggests that COVID-19 should be suspected in patients with acute 4 respiratory illness and fever plus travel to or residence in an endemic area or contact with a 5 confirmed or suspected COVID-19 case in the 14 days before symptom onset and in patients 6 with severe acute respiratory illness who require hospitalization without an alternative diagnosis 7 that fully explains the clinical presentation (10) . COVID-19 has variety of clinical presentations. 8 Geriatric patients with comorbidities are more vulnerable to severe disease. 9 The most common symptoms are but not specific: fever, cough, fatigue, and dyspnoea (1,11,12). 10 Bilateral pulmonary infiltrates are typically seen in. Patients often develop a severe acute 11 respiratory distress syndrome (ARDS). As far as the COVID 19 spread increased badly, the ICU 12 settings should be prepared with staff and adequate resources and everybody should be suspected 13 unless otherwise ruled out with diagnostic testing for COVID-19 (1). 14 3. 2. Admission criteria of patients with COVID 19 to intensive care unit (ICU) 15 All patients with COVID 19 were not admitted to the ICU. Hence, ICU admissions are 16 dependent on the severity of illness and the ICU capacity of the health-care system. Among 17 COVID 19 cases, about 5% become critically ill and require intensive care treatment. Acute 18 hypoxemic failure with severe dyspnea and an increased respiratory rate (>30 breaths/min) 19 usually leads to ICU admission (1,2). According to the Swiss Society of Intensive Care 20 Medicine recommendations which basis early warning score recommended that a score of >6 21 points (age >65 years, fever >39 °C, lymphopenia and neutropenia, lactate dehydrogenase (LDH) 22 increase, increased D-dimers) are candidates for ICU admission (13). in an isolation room with 16 air changes/hour were studied and concluded that HFNC had high 6 aerosol generating risk (1,20,21). For patients with COVID-19 who require endotracheal 7 intubation, use of low tidal volume (6 mL/kg per predicted bodyweight) with a plateau airway 8 pressure of less than 30 cm H2O, and increasing the respiratory rate to 35 breaths per min as 9 needed, is the mainstay of lung-protective ventilation (22) . Treatment and therapy options with 10 its current recommendation is displayed by (Table 2) . age are all commonly associated with high risk for malnutrition, representing per se a relevant 18 risk factor for higher morbidity and mortality in chronic and acute disease (27). 19 The nutritional assessment and the early nutritional care management of COVID-19 patients In the setting of COVID-19, hypoxemic respiratory failure secondary to the virus itself is There is current uncertainty regarding the role of tracheostomy for weaning ventilated patients 20 with COVID-19 pneumonia. This is due to a number of factors including prognosis, optimal 21 healthcare resource utilisation, and safety of healthcare workers when performing such a high- Early rehabilitation seems not well tolerated, with rapid desaturation. the following issues have 5 been diagnosed up to now: dysphagia, muscle weakness, critical illness myopathy and 6 neuropathy, reduced joint mobility, neck and shoulder pain (due to prolonged proning), difficulty 7 in verticalization, impaired balance and gait, limitations in activities of daily living (ADL), 8 difficult awakening with long-lasting confusional state and psychological problems (49).

Survivors requiring prolonged rehabilitation are more likely to be older and to have preexisting 10 cardiovascular and cerebrovascular disease, which may influence their rehabilitation and 11 outcomes (48,50). Sample evidences of literatures are summarized below (Table 3) . 

Considerations of clients with comorbidity  Tight glycemic control, avoiding hypoglycemia and glucose

 Reducing patients' coughing  Replacing the tracheal tube with an supraglottic airway before emergence Acknowledgement: My grateful gratitude was going to not only the University at large but also 10 to all the teams of the study. 

Treatment for severe acute respiratory distress 2 syndrome from COVID-19 Rational use of face masks in the COVID-19 pandemic

Nutritional 6 management of COVID-19 patients in a rehabilitation unit

Nutrition of the COVID-19 patient 8 in the intensive care unit (ICU): A practical guidance

Elsevier has created a COVID-19 resource centre with free 12 information in English and Mandarin on the novel coronavirus COVID-19 . The COVID-13 19 resource centre is hosted on Elsevier Connect , the company ' s public news and 14 information

ESPEN expert statements and practical guidance for nutritional management of 17 individuals with SARS-CoV-2 infection. Clinical Nutrition. 2020. 18 28. Guidelines T. COVID-19 Treatment Guidelines 2

Elsevier has created a COVID-19 resource centre with free 11 information in English and Mandarin on the novel coronavirus COVID-research that is 12 available on the COVID-19 resource centre -including this for unrestricted research re-13 use a

Asthma increases risk of severity of COVID-19

Factors associated with COVID-19 infections 16 and mortality in Africa: A cross-sectional study using publicly available data

Association of Obesity with Disease Severity Among Patients with Coronavirus Disease

Predictive symptoms and comorbidities for severe COVID-19 and 1 intensive care unit admission: a systematic review and meta-analysis. International Journal 2 of Public Health

Incidence of thrombotic complications in critically ill ICU patients with COVID-19

Prevalence and impact of 7 cardiovascular metabolic diseases on COVID-19 in China

Care for Critically Ill Patients with COVID-19

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Safe Extubation in COVID19

Extubation of patients with 18 COVID-19

Extubation and the Risks of Coughing and Laryngospasm 20 in the Era of Coronavirus Disease-19 (COVID-19)