Journey of an intensive care doctor to the heart of COVID-19, by Dr Pascal Sacré
"AIMSIB asked Dr Pascal Sacré, an intensive care physician, to give us the state of knowledge on Covid-19 therapeutics in this month of October 2020"
"One of the most frequent serious conditions encountered in intensive care affects respiratory function, namely the oxygenation of the blood (O2) and the elimination of carbon dioxide (CO2), a product of metabolism, through damage to the organ of respiration, the lungs. This is ARDS, Acute Respiratory Distress Syndrome."
"Oxygen is vital. Some organs are absolutely dependent on it, and oxygen deprivation for a few minutes can have serious consequences, particularly for the brain or the heart. A drop in blood oxygen is called hypoxaemia; it is THE problem of ARDS (or SDRA)."
"This is the initial vital problem of COVID-19: severe hypoxaemia."
"Key points:"
"Severe COVID-19 pneumonia manifests as ARDS (SDRA) with severe hypoxaemia. Another well-known viral pneumonia that can cause ARDS (SDRA) is influenza. ARDS (SDRA) was characterised in 1967. In 50 years, its mortality has remained high, 40 to 50%, i.e. 1 patient in 2. Management is standardised, essentially symptomatic, and targets hypoxaemia (lack of oxygen in the blood)."
"The treatments used have been conventional, mainly those used in any ARDS (SDRA):
– Oxygen therapy by enriching the inspired air with oxygen, up to 100% (pure oxygen)
– Positive pressure ventilation
– Use of intermittent prone positioning (lying on the stomach)
– Antibiotic therapy as indicated, as early as possible
– Anticoagulation at therapeutic (curative) doses
– Corticosteroids: reinventing the wheel"
"COVID-19 for an intensive care doctor: the controversial treatments"
"The place of hydroxychloroquine and azithromycin
-Early phase (first day of symptom onset)
-Pre-hospital (outpatient, general practitioners)"
"Monitoring by front-line doctors, GPs in outpatient settings, or emergency physicians."
"The place of zinc and vitamins D and C:
– Pre-hospital
– Hospital
– Intensive care"
"Dr Pascal Sacré
October 2020"
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