Severe COVID-19 Infections—Knowledge Gained and Remaining Questions | Critical Care Medicine | JAMA Internal Medicine | JAMA Network
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September 18, 2020

Severe COVID-19 Infections—Knowledge Gained and Remaining Questions

Author Affiliations
  • 1Intensive Care and Department of Respiratory Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
  • 2Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
  • 3Center for Acute Respiratory Failure, New York-Presbyterian Hospital, New York, New York
  • 4Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Department of Medicine, University of California, San Francisco
  • 5Department of Anesthesia and Perioperative Care, University of California, San Francisco
JAMA Intern Med. Published online September 18, 2020. doi:10.1001/jamainternmed.2020.6047

Patients with acute respiratory failure due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have overwhelmed critical care capacity in some cities and countries. The mortality of patients who require critical care is high but varies widely among hospitals.1 Despite a rapidly increasing understanding of the pathogenesis of coronavirus disease 2019 (COVID-19), uncertainty remains about the reasons that some patients develop respiratory failure and others have no to minimal symptoms, as well as about the optimal management of patients with severe COVID-19 disease.2 We review the evidence for the management of patients with the acute respiratory distress syndrome (ARDS) that may apply to patients with severe COVID-19, what has been learned about treatment of these patients, and the gaps in knowledge that remain.

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    1 Comment for this article
    anticoagulants in CoVID19
    Camilo Colaco, PhD | ImmunoBiology Ltd
    Both endothelial activation or coagulopathy results in the formation of microthrombi, so the early administration of anti-coagulants like LMW heparin should be beneficial as indicated by observational studies in China (1) and the US (2). The correlation of elevated d-dimer levels with mortality suggest that early treatment with LMW heparin should significantly reduce mortality.
    1.Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe coronavirus disease 2019 patients with coagulopathy. J Thromb Haemost. 2020;18:1094–1099.
    2, Hippensteel JA, LaRiviere WB, Colbert JF, Langouët-Astrié CJ, Schmidt EP. Heparin as a
    therapy for COVID-19: current evidence and future possibilities. Am J Physiol Lung Cell Mol Physiol 319: L211–L217, 2020.