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].