Supportive early therapy and monitoring – SARS
In the context of SARS, it is necessary to administer supplemental
oxygen therapy immediately to patients with SARS and difficulty
breathing, hypoxemia, or shock with a SpO2 target> 94%
[14]. In adults with signs of emergency (obstruction or shortness of
breath, severe respiratory distress, central cyanosis, shock, coma, or
seizures), they must receive airway management and oxygen therapy during
resuscitation to achieve SpO2 ≥ 94% [. It is necessary to start
oxygen therapy at 5 L/min and assess flow rates to reach the SpO2 target
≥ 93% during resuscitation, or use a face mask with a reservoir bag
(10-15 L/min) if the patient is in a healthy state critical [14].
After patient stabilization, the target is SpO2> 90% in
adults (without pregnancy) and ≥ 92% -95% in pregnant patients. In
children with emergency signs (obstruction or shortness of breath,
severe respiratory distress, central cyanosis, shock, coma, or seizures)
they must receive airway management and oxygen therapy during
resuscitation to achieve SpO2 ≥ 94%, otherwise, the goal is SpO2 ≥
90%. The use of a nasal cannula is preferable in young children, as
they can be better tolerated [15].
Still, it has indicated to use a conservative treatment of fluids in
patients with SARS when there is no evidence of shock [16]. Patients
with SARS should be treated cautiously with intravenous fluids, as
aggressive fluid resuscitation can worsen oxygenation, especially in
environments where the availability of mechanical ventilation is
limited. This applies to the care of children and adults. It has also
indicated to administer antibiotics within an hour of the initial
assessment of patients with sepsis, to collect cultures within an hour
ideally before starting the antibiotic and descale based on the
microbiological result or clinical judgment [17,18].
Also, it was indicated not to routinely administer systemic
corticosteroids for the treatment of viral pneumonia or SARS outside
clinical trials, except for other reasons. It is necessary to closely
monitor patients with SARS for signs of clinical complications such as
respiratory failure and rapidly progressing sepsis and apply supportive
interventions immediately [19].
Laboratory tests of hematology and biochemistry and ECG should be
performed on admission and as clinically indicated to monitor
complications, such as acute liver injury, acute kidney injury, acute
cardiac injury, or shock. The application of timely, effective, and safe
supportive therapies is the mainstay of therapy for patients who develop
severe manifestations of COVID-19 [20]. In pregnant patients, after
their resuscitation and stabilization, it is necessary to analyze the
fetus. It is a differential to understand the patient’s comorbidities
for individualized care and prognosis. Thus, Table 1 below presents the
major clinical syndromes associated with SARS-CoV-2 infection [1].
Table 1. Clinical syndromes associated with SARS-CoV-2
infection [1].