[Artigo] Critical care management of adults with community-acquired severe respiratory viral infection
Abstract – Critical care management of adults with community-acquired severe respiratory viral infection
With the expanding use of molecular assays, viral pathogens are increasingly recognized among critically ill adult patients with community-acquired severe respiratory illness; studies have detected respiratory viral infections (RVIs) in 17–53% of such patients. In addition, novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identifed. Patients with severe RVIs requiring ICU care present typically with hypoxemic respiratory failure. Oseltamivir is the most widely used neuraminidase inhibitor for treatment of infuenza; data suggest that early use is associated with reduced mortality in critically ill patients with infuenza. At present, there are no antiviral therapies of proven efcacy for other severe RVIs. Several adjunctive pharmacologic interventions have been studied for their immunomodulatory efects, including macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-infuenza immune plasma, and vitamin C, but none is recommended at present in severe RVIs. Evidence-based supportive care is the mainstay for management of severe respiratory viral infection. Non-invasive ventilation in patients with severe RVI causing acute hypoxemic respiratory failure and pneumonia is associated with a high likelihood of transition to invasive ventilation. Limited existing knowledge highlights the need for data regarding supportive care and adjunctive pharmacologic therapy that is specifc for critically ill patients with severe RVI. There is a need for more pragmatic and efcient designs to test diferent therapeutics both individually and in combination.
Introduction
With the expanding use of molecular assays, viral pathogens are increasingly detected among critically ill adult patients with respiratory illness; studies have reported a prevalence between 17% and 53% of patients (Table 1), depending on study design, sample type, duration of illness, and assay methods. Common viruses that can cause severe respiratory viral infections (RVIs) include infuenza A and B viruses, picornaviruses (rhinovirus, enterovirus [e.g., enterovirus D68]), human coronaviruses (229E, NL63, OC43, HKU1), respiratory syncytial virus (RSV), human metapneumovirus, parainfuenza virus, and adenovirus (Tables 1 and 2). Novel pathogens including zoonotic coronaviruses like the agents causing Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the 2019 novel coronavirus (2019 nCoV) are still being identifed (Table 2).
Para continuar lendo o artigo, clique aqui.
