A study of adults admitted with COVID-19 pneumonia revealed risk factors associated with developing acute respiratory distress syndrome (ARDS) and progression from ARDS to death included older age, neutrophilia, organ dysfunction, and coagulation derangement.
COVID-19 is a systemic disease that primarily injures the vascular endothelium, causing a unique lung injury in which different management strategies may need to be considered to address the specific physiology of each patient.
In this randomized trial, daily maximal recruitment trials failed to reduce ventilator-free days in the setting of acute respiratory distress syndrome, but increased the risk of cardiovascular adverse effects.
When the early use of a continuous infusion of cisatracurium was compared to contemporary supportive care for moderate-to-severe ARDS, including a light sedation target, high positive-end expiratory pressure, and conservative fluid strategy, there was no difference in 90-day mortality. Patients in the early neuromuscular blockade group more frequently experienced a severe cardiovascular event and ICU-acquired weakness by day 28.