A Narrative Review on Critical Care Management of Community‑Acquired Severe Respiratory Viral Infections
Respiratory viral infections (RVI) are increasingly recognised in patients with community-acquired severe respiratory illness. In addition, novel zoonotic coronaviruses are moving into focus.
The review outlines the current knowledge about the management of severe RVI, focusing on five main topics: the antiviral therapy, the adjunctive pharmacologic interventions, the antibacterial therapy, the supportive care and the future directions for research.
Evidence-based supportive care remains the key for the clinical management of severe RVI. Current knowledge about non-invasive and invasive ventilation, prone positioning, neuromuscular blockers, ECMO, cardiovascular management and infection prevention are discussed by the authors.
Early treatment with neuraminidase inhibitors is associated with reduced mortality only in severe influenza. There are no antiviral therapies of proven efficacy for other severe RVI.
Macrolides, corticosteroids, cyclooxygenase-2 inhibitors, sirolimus, statins, anti-influenza immune plasma, and vitamin C are some of the adjunctive pharmacologic interventions studied for their immunomodulatory effects, but at present, none of these is recommended for cases of severe RVI.
The review highlights the need for data regarding supportive care and adjunctive pharmacologic therapy specifically for critically ill patients with severe RVI.
Considering the increasing worldwide attention to severe RVI, the review may be a valid support for the most common management questions occurring in routine clinical practice in patients with community-acquired severe RVI.
TAKE HOME MESSAGE
Evidence-based supportive care is the mainstay for management of severe respiratory viral infection.
More efficient studies and RCT could represent an approach to test antiviral therapeutics, individually and in combination, in patients with severe RVI.
This article review was prepared and submitted by Dr Serena Ranieri, Department of Anaesthesiology and Intensive Care, University Hospital of Modena, Modena, Italy, on behalf of the ESICM Journal Review Club.
Arabi, Y.M., Fowler, R. & Hayden, F.G. Critical care management of adults with community-acquired severe respiratory viral infection. Intensive Care Med 46, 315–328 (2020).