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DOI: 10.1055/a-1314-9342
COVID-19: Intensivmedizinische Aspekte und Langzeitfolgen
COVID-19: Intensive Care Aspects and Long-Term Effects![](https://www.thieme-connect.de/media/aktkardio/202101/lookinside/thumbnails/10-1055-a-1314-9342_ka0234-1.jpg)
Zusammenfassung
Etwa 14% der COVID-19-Patienten weisen einen schwereren und ca. 5% einen kritischen Krankheitsverlauf auf. Besonders gefährdet sind ältere Personen, männliches Geschlecht, Raucher und stark adipöse Menschen. Wird der Patient invasiv oder nichtinvasiv beatmet, so steigt die Mortalität auf 53% respektive 50% an. In der Regel beträgt die Dauer vom Beginn der Symptome bis zur Aufnahme auf die Intensivstation 10 Tage. Die mittlere Verweildauer auf der Intensivstation beträgt 9 Tage. Für die Priorisierung sind die klinische Erfolgsaussicht einer intensivmedizinischen Behandlung sowie der Wunsch des Patienten maßgebend. Zentrale Kriterien für die Aufnahme auf die Intensivstation sind eine Hypoxämie (SpO2 < 90% unter 2 – 4 Liter Sauerstoff/min bei nicht vorbestehender Therapie), Dyspnoe, eine erhöhte Atemfrequenz (> 25 – 30/min) und ein systolischer Blutdruck ≤ 100 mmHg. Der Schutz des Personals genießt bei allen Maßnahmen Vorrang. Alle aerosolgenerierenden Prozeduren sollten nur mit großer Vorsicht erfolgen. Wird unter High Flow keine adäquate Oxygenierung erreicht (SpO2 ≥ 90% oder ein paO2 > 55 mmHg), sollte über eine Eskalation nachgedacht werden (NIV, invasive Beatmung). Die Patienten sollten lungenprotektiv beatmet werden. Die Intubation sollte als Rapid Sequence Induction erfolgen. Eine ECMO kann erwogen werden. Thrombembolische Komplikationen sind sehr häufig. Antibiotika sollten nicht routinemäßig gegeben werden. Die aktuell beste Datenlage liegt für Dexamethason vor. Remdesivir kann die Rekonvaleszenz beschleunigen. Langzeitfolgen nach COVID-19 sind sehr häufig. Kardiale, pulmonale und neurologische Probleme stehen dabei im Vordergrund.
Abstract
Approximately 14% of COVID-19 patients have a more severe and approximately 5% a critical course of disease. The elderly, males, smokers, and severely obese people are particularly at risk. If the patient is ventilated invasively or non-invasively, mortality rises to 53% and 50% respectively. As a rule, it takes ten days from the onset of symptoms to admission to the intensive care unit. The average length of stay in the intensive care unit is nine days. Prioritization is based on the clinical chances of success of intensive care treatment and the patientʼs wishes. Central criteria for admission to the intensive care unit are hypoxemia (SpO2 < 90% by admitting 2 – 4 liters of oxygen/min., if no pre-existing therapy is used), dyspnea, an increased respiratory rate (> 25 – 30/min) and systolic blood pressure ≤ 100 mmHg. The protection of the personnel has priority in all measures. All aerosol generating procedures should be performed with great care. If adequate oxygenation is not achieved under high flow (SpO2 ≥ 90% or a paO2 > 55 mmHg), escalation should be considered (NIV, invasive ventilation). The patients should be ventilated lung-protectively. Intubation should be performed as rapid sequence induction. An ECMO can be considered. Thromboembolic complications are very frequent. Antibiotics should not be given routinely. The best data currently available is for dexamethasone. Remdesivir can accelerate the convalescence. Long-term consequences after COVID-19 are very common. Cardiac, pulmonary, and neurological problems are in the foreground.
Für die Intensivmedizin ist COVID-19 von großer Bedeutung. Wichtig sind dabei eine frühzeitige Priorisierung bei der Zuteilung der Kapazitäten, eine lungenprotektive Beatmung und mindestens prophylaktische Antikoagulation.
Die Langzeitfolgen umfassen vor allem kardiale, pulmonale und neurologische Symptome.
Publication History
Article published online:
14 December 2020
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Literatur
- 1 Stringhini S, Wisniak A, Piumatti G. et al. Seroprevalence of anti-SARS-CoV-2 IgG antibodies in Geneva, Switzerland (SEROCoV-POP): a population-based study. Lancet 2020; 396: 313-319 doi:10.1016/S0140-6736(20)31304-0
- 2 Fischer B, Knabbe C, Vollmer T. SARS-CoV-2 IgG seroprevalence in blood donors located in three different federal states, Germany, March to June 2020. Euro Surveill 2020; 25: 2001285 doi:10.2807/1560-7917.ES.2020.25.28.2001285
- 3 Herrmann BL. [The prevalence rate of anti-SARS-CoV-2-IgG is 1.2% – Screening in asymptomatic outpatients in Germany (Northrhine-Westfalia)]. MMW Fortschr Med 2020; 162: 44-46 doi:10.1007/s15006-020-0750-y
- 4 Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020; 323: 1239-1242 doi:10.1001/jama.2020.2648
- 5 Karagiannidis C, Mostert C, Hentschker C. et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. Lancet Respir Med 2020; DOI: 10.1016/S2213-2600(20)30316-7.
- 6 Yang X, Yu Y, Xu J. et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med 2020; 8: 475-481 doi:10.1016/S2213-2600(20)30079-5
- 7 Grasselli G, Zangrillo A, Zanella A. et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; DOI: 10.1001/jama.2020.5394.
- 8 Cummings MJ, Baldwin MR, Abrams D. et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet 2020; 395: 1763-1770 doi:10.1016/S0140-6736(20)31189-2
- 9 Rey JR, Caro-Codon J, Rosillo SO. et al. Heart Failure In Covid-19 Patients: Prevalence, Incidence And Prognostic Implications. Eur J Heart Fail 2020; DOI: 10.1002/ejhf.1990.
- 10 Kluge S, Janssens U, Welte T. et al. Empfehlungen zur intensivmedizinischen Therapie von Patienten mit COVID-19. Med Klin Intensivmed Notfmed 2020; 115: 175-177 doi:10.1007/s00063-020-00674-3
- 11 Wong HYF, Lam HYS, Fong AH. et al. Frequency and Distribution of Chest Radiographic Findings in Patients Positive for COVID-19. Radiology 2020; 296: E72-E78 doi:10.1148/radiol.2020201160
- 12 Bao C, Liu X, Zhang H. et al. Coronavirus Disease 2019 (COVID-19) CT Findings: A Systematic Review and Meta-analysis. J Am Coll Radiol 2020; 17: 701-709 doi:10.1016/j.jacr.2020.03.006
- 13 Marggrander DT, Borgans F, Jacobi V. et al. Lung Ultrasound Findings in Patients with COVID-19. SN Compr Clin Med 2020; DOI: 10.1007/s42399-020-00553-0.
- 14 Vrettou AR, Parissis J, Ikonomidis I. The Dual Role of Echocardiography in the Diagnosis of Acute Cardiac Complications and Treatment Monitoring for Coronavirus Disease 2019 (COVID-19). Front Cardiovasc Med 2020; 7: 129 doi:10.3389/fcvm.2020.00129
- 15 Dweck MR, Bularga A, Hahn RT. et al. Global evaluation of echocardiography in patients with COVID-19. Eur Heart J Cardiovasc Imaging 2020; 21: 949-958 doi:10.1093/ehjci/jeaa178
- 16 Szekely Y, Lichter Y, Taieb P. et al. Spectrum of Cardiac Manifestations in COVID-19: A Systematic Echocardiographic Study. Circulation 2020; 142: 342-353 doi:10.1161/CIRCULATIONAHA.120.047971
- 17 Bellani G, Laffey JG, Pham T. et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017; 195: 67-77 doi:10.1164/rccm.201606-1306OC
- 18 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020; 383: 120-128 doi:10.1056/NEJMoa2015432
- 19 Barbaro RP, MacLaren G, Boonstra PS. et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet 2020; 396: 1071-1078 doi:10.1016/S0140-6736(20)32008-0
- 20 Nadkarni GN, Lala A, Bagiella E. et al. Anticoagulation, Mortality, Bleeding and Pathology Among Patients Hospitalized with COVID-19: A Single Health System Study. J Am Coll Cardiol 2020; DOI: 10.1016/j.jacc.2020.08.041.
- 21 Siemieniuk RA, Bartoszko JJ, Ge L. et al. Drug treatments for covid-19: living systematic review and network meta-analysis. BMJ 2020; 370: m2980 doi:10.1136/bmj.m2980
- 22 Group RC, Horby P, Lim WS. et al. Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report. N Engl J Med 2020; DOI: 10.1056/NEJMoa2021436.
- 23 Morena V, Milazzo L, Oreni L. et al. Off-label use of tocilizumab for the treatment of SARS-CoV-2 pneumonia in Milan, Italy. Eur J Intern Med 2020; 76: 36-42 doi:10.1016/j.ejim.2020.05.011
- 24 Furlow B. COVACTA trial raises questions about tocilizumabʼs benefit in COVID-19. Lancet Rheumatol 2020; 2: e592 doi:10.1016/S2665-9913(20)30313-1
- 25 Pasquini Z, Montalti R, Temperoni C. et al. Effectiveness of remdesivir in patients with COVID-19 under mechanical ventilation in an Italian ICU. J Antimicrob Chemother 2020; DOI: 10.1093/jac/dkaa321.
- 26 Grein J, Ohmagari N, Shin D. et al. Compassionate Use of Remdesivir for Patients with Severe Covid-19. N Engl J Med 2020; 382: 2327-2336 doi:10.1056/NEJMoa2007016
- 27 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the Treatment of Covid-19 – Preliminary Report. N Engl J Med 2020; DOI: 10.1056/NEJMoa2007764.
- 28 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med 2020; DOI: 10.1056/NEJMoa2007764.
- 29 Piechotta V, Chai KL, Valk SJ. et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2020; (07) CD013600 DOI: 10.1002/14651858.CD013600.pub2.
- 30 Griffin S. Covid-19: Lopinavir-ritonavir does not benefit hospitalised patients, UK trial finds. BMJ 2020; 370: m2650 doi:10.1136/bmj.m2650
- 31 Grimaldi D, Aissaoui N, Blonz G. et al. Characteristics and outcomes of acute respiratory distress syndrome related to COVID-19 in Belgian and French intensive care units according to antiviral strategies: the COVADIS multicentre observational study. Ann Intensive Care 2020; 10: 131 doi:10.1186/s13613-020-00751-y
- 32 Bessiere F, Roccia H, Deliniere A. et al. Assessment of QT Intervals in a Case Series of Patients With Coronavirus Disease 2019 (COVID-19) Infection Treated With Hydroxychloroquine Alone or in Combination With Azithromycin in an Intensive Care Unit. JAMA Cardiol 2020; 5: 1067-1069 doi:10.1001/jamacardio.2020.1787
- 33 Nabavi N. Long covid: How to define it and how to manage it. BMJ 2020; 370: m3489 doi:10.1136/bmj.m3489
- 34 Puntmann VO, Carerj ML, Wieters I. et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020; DOI: 10.1001/jamacardio.2020.3557.
- 35 Carvalho-Schneider C, Laurent E, Lemaignen A. et al. Follow-up of adults with non-critical COVID-19 two months after symptomsʼ onset. Clin Microbiol Infect 2020; DOI: 10.1016/j.cmi.2020.09.052.
- 36 Greenhalgh T, Knight M, AʼCourt C. et al. Management of post-acute covid-19 in primary care. BMJ 2020; 370: m3026 doi:10.1136/bmj.m3026
- 37 Heneka MT, Golenbock D, Latz E. et al. Immediate and long-term consequences of COVID-19 infections for the development of neurological disease. Alzheimers Res Ther 2020; 12: 69 doi:10.1186/s13195-020-00640-3
- 38 Siepmann T, Sedghi A, Simon E. et al. Increased risk of acute stroke among patients with severe COVID-19: a multicenter study and meta-analysis. Eur J Neurol 2020; DOI: 10.1111/ene.14535.
- 39 Liu N, Zhang F, Wei C. et al. Prevalence and predictors of PTSS during COVID-19 outbreak in China hardest-hit areas: Gender differences matter. Psychiatry Res 2020; 287: 112921 doi:10.1016/j.psychres.2020.112921
- 40 Hickie I, Davenport T, Wakefield D. et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ 2006; 333: 575 doi:10.1136/bmj.38933.585764.AE
- 41 Morley JE, Kalantar-Zadeh K, Anker SD. COVID-19: a major cause of cachexia and sarcopenia?. J Cachexia Sarcopenia Muscle 2020; 11: 863-865 doi:10.1002/jcsm.12589
- 42 Shams A, Morley JE. Editorial: Autonomic Neuropathy and Cardiovascular Disease in Aging. J Nutr Health Aging 2018; 22: 1028-1033 doi:10.1007/s12603-018-1097-2
- 43 Becker RC. Anticipating the long-term cardiovascular effects of COVID-19. J Thromb Thrombolysis 2020; 50: 512-524 doi:10.1007/s11239-020-02266-6