As September begins, it’s important to remember that it’s Sepsis Awareness Month, and while the International Guidelines for Management of Sepsis and Septic Shock 2016 direct sepsis care, there are some caveats to the guidelines when caring for coronavirus disease 2019 (COVID-19) patients who develop sepsis. In fact, specific guidelines on managing critically ill patients with COVID-19 were published in June 2020. The most significant difference in caring for COVID-19 patients with sepsis is recommendation #9:

“For the acute resuscitation of adults with COVID-19 and shock, we suggest using a conservative over a liberal fluid strategy (Alhazzani et al., 2020).”

In a recent conversation with Anne Dabrow Woods, Chief Nurse of Wolters Kluwer, Health Learning, Research & Practice; adjunct faculty for Drexel University; and critical care nurse practitioner for Penn Medicine, Chester County Hospital, we dug a little deeper into fluid resuscitation for COVID-19. Here are some highlights from our conversation:

“COVID-19 patients don’t like a lot of fluid because it will flood their alveoli. We are using a more conservative versus liberal volume resuscitation strategy.”

“The other caveat is that we use a buffered crystalloid, and in this case, it would be Lactated Ringers.”

“If the patient develops a secondary bacterial pneumonia…we want to figure that out quickly…and get them on empiric antibiotic coverage for gram-positive and gram-negative organisms.”

“If they still have a ‘soft’ blood pressure, meaning that they’re hypotensive…we’re going to go ahead and start them on vasopressors, and the recommendations are the same as for regular sepsis, meaning norepinephrine is going to be your first-line agent, followed by vasopressin as your second-line agent.”

Listen to our whole conversation here; we discuss all of the latest updates in managing critically ill patients with COVID-19. Also, explore these resource centers for more on the topics of sepsis and COVID-19.


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Latest Updates in COVID Management

References:

Alhazzani, W., Moller, M., Arabi, Y., Loeb, M., Gong, M., Fan, E.,…Rhodes, A., (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Critical Care Medicine, 48(6), e440-e469. https://www.doi.org/10.1097/CCM.0000000000004363

Rhodes, A., Evans, L., Alhazzani, W., Levy, M., Antonelli, M., Ferrer, R., . . . Dellinger, R. (2017). Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock 2016. Critical Care Medicine, 486-452. https://www.doi.org/10.1097/CCM.0000000000002255

Woods, A. (2020).  Latest Updates in COVID-19 Management. Lippincott NursingCenter. https://www.nursingcenter.com/journals-articles/podcast-library/latest-updates-in-covid-management