Abstract
The management of patients with severe to critical forms of Covid-19 in the intensive care unit includes oxygen therapy to treat the deep hypoxaemia induced by the disease, either delivered non-invasively (high concentration mask, high flow oxygen therapy, NIV) or invasively after oro-tracheal intubation in the most severe forms. The symptomatic management becomes then similar to that of an acute respiratory distress syndrome (ARDS) of other origin with the introduction of protective mechanical ventilation, sedation or even curarisation, and prone positioning in the most hypoxemic patients. Other organ failures, including haemodynamic and renal failures, should also be diagnosed and treated. Thrombo-prophylaxis at a higher than usual dose (intermediate or even curative dose) should also be initiated in the acute phase of the disease. Finally, specific treatment is mainly based on systemic corticosteroid therapy with dexamethasone 6 mg/d, possibly combined with tocilizumab. Other Covid-19-specific treatments have not yet been proven to be effective in critical care patients.
