Pragmatic recommendations for the management of COVID-19 patients with shock in low- And middle-income countries

Stephanie Maximous, Brian Jason Brotherton, Andrew Achilleos, Kevan M. Akrami, Lia M. Barros, Natalie Cobb, David Misango, Alfred Papali, Casey Park, Varun U. Shetty, Marcus J. Schultz, Shaurya Taran, Burton W. Lee

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

As some patients infected with the novel coronavirus progress to critical illness, a subset will eventually develop shock. High-quality data on management of these patients are scarce, and further investigation will provide valuable information in the context of the pandemic. A group of experts identify a set of pragmatic recommendations for the care of patients with SARS-CoV-2 and shock in resource-limited environments. We define shock as life-threatening circulatory failure that results in inadequate tissue perfusion and cellular dysoxia/hypoxia, and suggest that it can be operationalized via clinical observations. We suggest a thorough evaluation for other potential causes of shock and suggest against indiscriminate testing for coinfections. We suggest the use of the quick Sequential Organ Failure Assessment (qSOFA) as a simple bedside prognostic score for COVID-19 patients and point-of-care ultrasound (POCUS) to evaluate the etiology of shock. Regarding fluid therapy for the treatment of COVID-19 patients with shock in low-middle–income countries, we favor balanced crystalloids and recommend using a conservative fluid strategy for resuscitation. Where available and not prohibited by cost, we recommend using norepinephrine, given its safety profile. We favor avoiding the routine use of central venous or arterial catheters, where availability and costs are strong considerations. We also recommend using low-dose corticosteroids in patients with refractory shock. In addressing targets of resuscitation, we recommend the use of simple bedside parameters such as capillary refill time and suggest that POCUS be used to assess the need for further fluid resuscitation, if available.
Original languageEnglish
Pages (from-to)72-86
Number of pages15
JournalAmerican journal of tropical medicine and hygiene
Volume104
Issue number3
Early online date21 Dec 2020
DOIs
Publication statusPublished - 1 Mar 2021

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