S2k-Leitlinie – Empfehlungen zur stationären Therapie von Patienten mit COVID-19^[*]

Zusammenfassung

Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten mit Coronavirus Disease 2019 (COVID-19) zeigt lediglich milde Symptome wie Husten und Fieber. Allerdings benötigen etwa 8 % eine stationäre Behandlung. Der frühzeitigen Klärung, ob eine stationäre und ggfs. intensivmedizinische Behandlung medizinisch sinnvoll und vom Patienten gewollt ist, kommt in der Pandemie eine besondere Bedeutung zu. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (> 30/min) führt i. d. R. zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln einige dieser Patienten ein akutes Lungenversagen (Acute Respiratory Distress Syndrome; ARDS). Eine Sterblichkeitsreduktion einer verfügbaren medikamentösen Therapie bei schwerer COVID-19-Erkrankung ist bisher lediglich für Dexamethason in randomisiert, kontrollierten Studien nachgewiesen. Das Hauptziel der supportiven Therapie besteht in der Sicherstellung einer ausreichenden Oxygenierung. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19-Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Medizinisch notwendige Handlungen am Patienten, die zur Aerosolbildung führen könnten, sollten mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.

Abstract

Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome – Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.

^* AWMF-Register-Nr. 113/001, Stand 23.11.2020

Publikationsverlauf

Artikel online veröffentlicht:
15. Januar 2021

• 14 Literatur

• 1 Kluge S, Janssens U, Welte T. et al. [Recommendations for critically ill patients with COVID-19]. Med Klin Intensivmed Notfmed 2020; 115: 175-177
• 2 Kluge S, Janssens U, Welte T. et al. [German recommendations for treatment of critically ill patients with COVID-19-version 3: S1-guideline]. Der Anaesthesist 2020; 69: 653-664
• 3 Kluge S, Janssens U, Spinner CD. et al. Clinical practice guideline: Recommendations on in-hospital treatment of patients with COVID-19. Dtsch Arztebl Int 2021; 118: 1-7
• 4 Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin e. V.. Neues Coronavirus (SARS-CoV-2) – Informationen für die hausärztliche Praxis. DEGAM S1-Handlungsempfehlung. https://www.awmf.org/leitlinien/detail/ll/053-054.html (letzter Zugriff 23.11.2020)
• 5 Robert Koch-Institut. Nationale Teststrategie – wer wird in Deutschland auf das Vorliegen einer SARS-CoV-2 Infektion getestet?. (05.11.2020, letzter Zugriff 23.11.2020): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Teststrategie/Nat-Teststrat.html
• 6 Robert Koch-Institut. Hinweise zur Testung von Patienten auf Infektion mit dem neuartigen Coronavirus SARS-CoV-2. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Vorl_Testung_nCoV.html#doc13490982bodyText4 (letzter Zugriff 23.11.2020)
• 7 Robert Koch-Institut. Epidemiologischer Steckbrief zu SARS-CoV-2 und COVID-19. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Steckbrief.html#doc13776792bodyText15 (letzter Zugriff 13.01.2021)
• 8 Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72314 Cases From the Chinese Center for Disease Control and Prevention. JAMA 2020;
• 9 Robert Koch-Institut. Aktueller Lage-/Situationsbericht des RKI zu COVID-19. https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Situationsberichte/Gesamt.html (letzter Zugriff 13.01.2021)
• 10 Karagiannidis C, Mostert C, Hentschker C. et al. Case characteristics, resource use, and outcomes of 10 021 patients with COVID-19 admitted to 920 German hospitals: an observational study. The Lancet. Respiratory Medicine 2020; 8: 853-862
• 11 Guan WJ, Liang WH, Zhao Y. et al. Comorbidity and its impact on 1590 patients with COVID-19 in China: a nationwide analysis. Eur Respir J 2020; 55: 2000547
• 12 Cummings MJ, Baldwin MR, Abrams D. et al. Epidemiology, clinical course, and outcomes of critically ill adults with COVID-19 in New York City: a prospective cohort study. Lancet (London, England) 2020;
• 13 Docherty AB, Harrison EM, Green CA. et al. Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: prospective observational cohort study. BMJ (Clinical research ed.) 2020; 369: m1985
• 14 Jakob CEM, Borgmann S, Duygu F. et al. First results of the “Lean European Open Survey on SARS-CoV-2-Infected Patients (LEOSS)”. Infection 2020; 1-11
• 15 Tartof SY, Qian L, Hong V. et al. Obesity and Mortality Among Patients Diagnosed With COVID-19: Results From an Integrated Health Care Organization. Ann Intern Med 2020;
• 16 Chung M, Bernheim A, Mei X. et al. CT Imaging Features of 2019 Novel Coronavirus (2019-nCoV). Radiology 2020;
• 17 Gattinoni L, Chiumello D, Caironi P. et al. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med 2020; 1-4
• 18 Gattinoni L, Coppola S, Cressoni M. et al. COVID-19 Does Not Lead to a “Typical” Acute Respiratory Distress Syndrome. Am J Respir Crit Care Med 2020; 201: 1299-1300
• 19 Grasselli G, Zangrillo A, Zanella A. et al. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. JAMA 2020; 323: 1574-1581
• 20 Richardson S, Hirsch JS, Narasimhan M. et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA 2020;
• 21 Edler C, Schröder AS, Aepfelbacher M. et al. Dying with SARS-CoV-2 infection-an autopsy study of the first consecutive 80 cases in Hamburg, Germany. Int J Legal Med 2020; 134: 1275-1284
• 22 Ackermann M, Verleden SE, Kuehnel M. et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020;
• 23 Langford BJ, So M, Raybardhan S. et al. Bacterial co-infection and secondary infection in patients with COVID-19: a living rapid review and meta-analysis. Clin Microbiol Infect 2020;
• 24 Nehls W, Delis S, Haberland B. et al. [Management of Patients with COVID-19 – Recommendations from a Palliative Care Perspective]. Pneumologie 2020; 74: 652-659
• 25 Gross O, Moerer O, Weber M. et al. COVID-19-associated nephritis: early warning for disease severity and complications?. Lancet (London, England) 2020; 395: e87-e88
• 26 Cheng Y, Luo R, Wang K. et al. Kidney disease is associated with in-hospital death of patients with COVID-19. Kidney Int 2020; 97: 829-838
• 27 Braun F, Lütgehetmann M, Pfefferle S. et al. SARS-CoV-2 renal tropism associates with acute kidney injury. Lancet (London, England) 2020; 396: 597-598
• 28 Werion A, Belkhir L, Perrot M. et al. SARS-CoV-2 Causes a Specific Dysfunction of the Kidney Proximal Tubule. Kidney Int 2020;
• 29 The European Society for Cardiology. ESC Guidance for the Diagnosis and Management of CV Disease during the COVID-19 Pandemic. https://www.escardio.org/Education/COVID-19-and-Cardiology/ESCCOVID-19-Guidance (Last update: 10 June 2020).
• 30 Li X, Pan X, Li Y. et al. Cardiac injury associated with severe disease or ICU admission and death in hospitalized patients with COVID-19: a meta-analysis and systematic review. Crit Care 2020; 24: 468
• 31 Babapoor-Farrokhran S, Gill D, Walker J. et al. Myocardial injury and COVID-19: Possible mechanisms. Life Sci 2020; 253: 117723
• 32 Puntmann VO, Carerj ML, Wieters I. et al. Outcomes of Cardiovascular Magnetic Resonance Imaging in Patients Recently Recovered From Coronavirus Disease 2019 (COVID-19). JAMA cardiology 2020;
• 33 Liotta EM, Batra A, Clark JR. et al. Frequent neurologic manifestations and encephalopathy-associated morbidity in Covid-19 patients. Ann Clin Transl Neurol 2020;
• 34 Frontera JA, Sabadia S, Lalchan R. et al. A Prospective Study of Neurologic Disorders in Hospitalized COVID-19 Patients in New York City. Neurology 2020;
• 35 Paterson RW, Brown RL, Benjamin L. et al. The emerging spectrum of COVID-19 neurology: clinical, radiological and laboratory findings. Brain 2020;
• 36 Ellul MA, Benjamin L, Singh B. et al. Neurological associations of COVID-19. The Lancet. Neurology 2020; 19: 767-783
• 37 Desai SV, Law TJ, Needham DM. Long-term complications of critical care. Crit Care Med 2011; 39: 371-379
• 38 Needham DM, Davidson J, Cohen H. et al. Improving long-term outcomes after discharge from intensive care unit: report from a stakeholders’ conference. Crit Care Med 2012; 40: 502-509
• 39 Berlit P. et al. Neurologische Manifestationen bei COVID-19 S-L. In: Deutsche Gesellschaft für Neurologie, Hrsg. Leitlinien für Diagnostik und Therapie in der Neurologie. 2020. Online (abgerufen am 08.10.2020): www.dgn.org/leitlinien
• 40 Rodriguez-Morales AJ, Cardona-Ospina JA, Gutiérrez-Ocampo E. et al. Clinical, laboratory and imaging features of COVID-19: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 34: 101623
• 41 Hu R, Han C, Pei S. et al. Procalcitonin levels in COVID-19 patients. Int J Antimicrob Agents 2020; 56: 106051
• 42 Guan WJ, Ni ZY, Hu Y. et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N Engl J Med 2020;
• 43 Wiersinga WJ, Rhodes A, Cheng AC. et al. Pathophysiology, Transmission, Diagnosis, and Treatment of Coronavirus Disease 2019 (COVID-19): A Review. JAMA 2020; 324: 782-793
• 44 Wu C, Chen X, Cai Y. et al. Risk Factors Associated With Acute Respiratory Distress Syndrome and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med 2020; 180: 934-943
• 45 Cheng L, Li H, Li L. et al. Ferritin in the coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis. J Clin Lab Anal 2020; 34: e23618
• 46 Antoch G, Urbach H, Mentzel HJ. et al. SARS-CoV-2/COVID-19: Empfehlungen für die Radiologische Versorgung – Eine Stellungnahme der Deutschen Röntgengesellschaft (DRG) und weiterer Fachgesellschaften. Rofo 2020; 192: 418-421
• 47 Huang C, Wang Y, Li X. et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet (London, England) 2020;
• 48 Liao X, Wang B, Kang Y. Novel coronavirus infection during the 2019–2020 epidemic: preparing intensive care units-the experience in Sichuan Province, China. Intensive Care Med 2020; 46: 357-360
• 49 Kiefl D, Eisenmann S, Michels G. et al. [German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. Med Klin Intensivmed Notfmed 2020; 115: 654-667
• 50 Robert Koch-Institut. Empfehlungen des RKI zu Hygienemaßnahmen im Rahmen der Behandlung und Pflege von Patienten mit einer Infektion durch SARS-CoV-2. Stand 09.09.2020 (letzter Zugriff 23.11.2020): https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Hygiene.html
• 51 Robert Koch-Institut. Ressourcenschonender Einsatz von Mund-Nasen-Schutz (MNS) und FFP-Masken (14. 4. 2020). BMG/BMAS/ABAS/RKI: Ressourcenschonender Einsatz von Mund-Nasen-Schutz (MNS) und FFP-Masken (14. 4. 2020). letzter Zugriff 23.11.2020: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Ressourcen_schonen_Masken.html
• 52 Robert Koch-Institut. COVID-19: Entlassungskriterien aus der Isolierung. letzter Zugriff 23.11.2020: https://www.rki.de/DE/Content/InfAZ/N/Neuartiges_Coronavirus/Entlassmanagement.html
• 53 Alhazzani W, Møller MH, Arabi YM. et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020; 46: 854-887
• 54 WHO. Clinical management of COVID-19. https://www.who.int/publications/i/item/clinical-management-of-covid-19 (Version vom 27.05.2020, letzter Zugriff 23.11.2020)
• 55 Deutsche Gesellschaft für Anästhesiologie & Intensivmedizin. S3-Leitlinie Invasive Beatmung und Einsatz extrakorporaler Verfahren bei akuter respiratorischer Insuffizienz. 2017. https://www.awmf.org (04.12.2017).
• 56 Pfeifer M, Ewig S, Voshaar T. et al. Positionspapier zur praktischen Umsetzung der apparativen Differenzialtherapie der akuten respiratorischen Insuffizienz bei COVID-19. Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin e. V. (DGP). Pneumologie 2020;
• 57 Rochwerg B, Einav S, Chaudhuri D. et al. The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med 2020;
• 58 Coppo A, Bellani G, Winterton D. et al. Feasibility and physiological effects of prone positioning in non-intubated patients with acute respiratory failure due to COVID-19 (PRON-COVID): a prospective cohort study. The Lancet. Respiratory Medicine 2020; 8: 765-774
• 59 Thompson AE, Ranard BL, Wei Y. et al. Prone Positioning in Awake, Nonintubated Patients With COVID-19 Hypoxemic Respiratory Failure. JAMA Intern Med 2020;
• 60 Ferrando C, Mellado-Artigas R, Gea A. et al. Awake prone positioning does not reduce the risk of intubation in COVID-19 treated with high-flow nasal oxygen therapy: a multicenter, adjusted cohort study. Crit Care 2020; 24: 597
• 61 Westhoff M, Schonhofer B, Neumann P. et al. Nicht-invasive Beatmung als Therapie der akuten respiratorischen Insuffizienz. S3-Leitlinie herausgegeben von der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e. V. Pneumologie 2015; 69: 719-756
• 62 Rochwerg B, Brochard L, Elliott MW. et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J 2017; 50
• 63 Bellani G, Laffey JG, Pham T. et al. Noninvasive Ventilation of Patients with Acute Respiratory Distress Syndrome. Insights from the LUNG SAFE Study. Am J Respir Crit Care Med 2017; 195: 67-77
• 64 Carteaux G, Millán-Guilarte T, De Prost N. et al. Failure of Noninvasive Ventilation for De Novo Acute Hypoxemic Respiratory Failure: Role of Tidal Volume. Critical Care Med 2016; 44: 282-290
• 65 Vianello A, Arcaro G, Molena B. et al. High-flow nasal cannula oxygen therapy to treat patients with hypoxemic acute respiratory failure consequent to SARS-CoV-2 infection. Thorax 2020; 75: 998-1000
• 66 Patel M, Gangemi A, Marron R. et al. Retrospective analysis of high flow nasal therapy in COVID-19-related moderate-to-severe hypoxaemic respiratory failure. BMJ Open Respir Res 2020; 7: e000650
• 67 Avdeev SN, Yaroshetskiy AI, Tsareva NA. et al. Noninvasive ventilation for acute hypoxemic respiratory failure in patients with COVID-19. Am J Emerg Med 2020;
• 68 Alviset S, Riller Q, Aboab J. et al. Continuous Positive Airway Pressure (CPAP) face-mask ventilation is an easy and cheap option to manage a massive influx of patients presenting acute respiratory failure during the SARS-CoV-2 outbreak: A retrospective cohort study. PloS one 2020; 15: e0240645
• 69 Aliberti S, Radovanovic D, Billi F. et al. Helmet CPAP treatment in patients with COVID-19 pneumonia: a multicentre cohort study. Eur Respir J 2020; 56: 2001935
• 70 Franco C, Facciolongo N, Tonelli R. et al. Feasibility and clinical impact of out-of-ICU non-invasive respiratory support in patients with COVID-19 related pneumonia. Eur Respir J 2020;
• 71 Santus P, Radovanovic D, Saderi L. et al. Severity of respiratory failure at admission and in-hospital mortality in patients with COVID-19: a prospective observational multicentre study. BMJ open 2020; 10: e043651
• 72 Raoof S, Nava S, Carpati C. et al. High-Flow, Noninvasive Ventilation and Awake (Nonintubation) Proning in Patients With Coronavirus Disease 2019 With Respiratory Failure. Chest 2020;
• 73 Fan E, Beitler JR, Brochard L. et al. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?. The Lancet. Respiratory Medicine 2020; 8: 816-821
• 74 Chew SY, Lee YS, Ghimiray D. et al. Characteristics and Outcomes of COVID-19 Patients with Respiratory Failure Admitted to a “Pandemic Ready” Intensive Care Unit – Lessons from Singapore. Ann Acad Med Singap 2020; 49: 434-448
• 75 Cabrini L, Landoni G, Zangrillo A. Minimise nosocomial spread of 2019-nCoV when treating acute respiratory failure. Lancet (London, England) 2020; 395: 685
• 76 Fowler RA, Guest CB, Lapinsky SE. et al. Transmission of severe acute respiratory syndrome during intubation and mechanical ventilation. Am J Respir Crit Care Med 2004; 169: 1198-1202
• 77 Schwarz K, Biller H, Windt H. et al. Characterization of exhaled particles from the human lungs in airway obstruction. J Aerosol Med Pulm Drug Deliv 2015; 28: 52-58
• 78 Simonds AK, Hanak A, Chatwin M. et al. Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections. Health Technol Assess 2010; 14: 131-172
• 79 Hui DS, Chow BK, Lo T. et al. Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. Eur Respir J 2019; 53: 1802339
• 80 Hui DS, Chow BK, Ng SS. et al. Exhaled air dispersion distances during noninvasive ventilation via different Respironics face masks. Chest 2009; 136: 998-1005
• 81 Hui DS, Hall SD, Chan MT. et al. Noninvasive positive-pressure ventilation: An experimental model to assess air and particle dispersion. Chest 2006; 130: 730-740
• 82 Wachs C, Grensemann J, Kluge S. High-Flow-Sauerstofftherapie – Schritt für Schritt. DMW (1946) 2020; 145: 693-697
• 83 Leonard S, Atwood Jr CW, Walsh BK. et al. Preliminary Findings on Control of Dispersion of Aerosols and Droplets During High-Velocity Nasal Insufflation Therapy Using a Simple Surgical Mask: Implications for the High-Flow Nasal Cannula. Chest 2020;
• 84 Darwiche K, Ross B, Gesierich W. et al. Empfehlungen zur Durchführung einer Bronchoskopie in Zeiten der COVID-19-Pandemie. Update 11/2020. 2020. https://pneumologie.de/fileadmin/user_upload/COVID-19/20201119_DGP_Bronchoskopie_CoViD-19.pdf
• 85 Greenland JR, Michelow MD, Wang L. et al. COVID-19 Infection: Implications for Perioperative and Critical Care Physicians. Anesthesiology 2020; 132: 1346-1361
• 86 Bhaskar ME, Arun S. SARS-CoV-2 Infection Among Community Health Workers in India Before and After Use of Face Shields. JAMA 2020; 324: 1348-1349
• 87 Cook TM, El-Boghdadly K, McGuire B. et al. Consensus guidelines for managing the airway in patients with COVID-19: Guidelines from the Difficult Airway Society, the Association of Anaesthetists the Intensive Care Society, the Faculty of Intensive Care Medicine and the Royal College of Anaesthetists. Anaesthesia 2020; 75: 785-799
• 88 Schälte G, Kehl F, Didion N. et al. Besonderheiten des Atemwegsmanagements bei Patienten mit vermuteter oder gesicherter COVID-19 Erkrankung und bei Patienten ohne Infektion während der Corona-Pandemie. Empfehlungen von DGAI und BDA. Anästh Intensivmed 2020; 132-136
• 89 Caputo KM, Byrick R, Chapman MG. et al. Intubation of SARS patients: infection and perspectives of healthcare workers. Can J Anaesth 2006; 53: 122-129
• 90 Simpson JP, Wong DN, Verco L. et al. Measurement of airborne particle exposure during simulated tracheal intubation using various proposed aerosol containment devices during the COVID-19 pandemic. Anaesthesia 2020;
• 91 Dalli J, Khan MF, Marsh B. et al. Evaluating intubation boxes for airway management. Br J Anaesth 2020;
• 92 Fried EA, Zhou G, Shah R. et al. Barrier Devices, Intubation, and Aerosol Mitigation Strategies: PPE in the Time of COVID-19. Anesth Analg 2020;
• 93 Yang SS, Zhang M, Chong JJR. Comparison of three tracheal intubation methods for reducing droplet spread for use in COVID-19 patients. Br J Anaesth 2020; 125: e190-e191
• 94 Sorbello M, Rosenblatt W, Hofmeyr R. et al. Aerosol boxes and barrier enclosures for airway management in COVID-19 patients: a scoping review and narrative synthesis. Br J Anaesth 2020;
• 95 De Jong A, Pardo E, Rolle A. et al. Airway management for COVID-19: a move towards universal videolaryngoscope?. The Lancet. Respiratory Medicine 2020; 8: 555
• 96 Orser BA. Recommendations for Endotracheal Intubation of COVID-19 Patients. Anesth Analg 2020; 130: 1109-1110
• 97 Piepho TCE, Noppens R, Byhahn C, Dörges V, Zwissler B, Timmermann A. S1 Leitlinie: Atemwegsmanagement. 2015. https://www.awmf.org
• 98 Peng PWH, Ho PL, Hota SS. Outbreak of a new coronavirus: what anaesthetists should know. Br J Anaesth 2020; 124: 497-501
• 99 Chiumello D, Busana M, Coppola S. et al. Physiological and quantitative CT-scan characterization of COVID-19 and typical ARDS: a matched cohort study. Intensive Care Med 2020; 1-10
• 100 Grasselli G, Tonetti T, Protti A. et al. Pathophysiology of COVID-19-associated acute respiratory distress syndrome: a multicentre prospective observational study. The Lancet. Respiratory Medicine 2020;
• 101 Ferrando C, Suarez-Sipmann F, Mellado-Artigas R. et al. Clinical features, ventilatory management, and outcome of ARDS caused by COVID-19 are similar to other causes of ARDS. Intensive Care Med 2020; 1-12
• 102 Botta M, Tsonas AM, Pillay J. et al. Ventilation management and clinical outcomes in invasively ventilated patients with COVID-19 (PRoVENT-COVID): a national, multicentre, observational cohort study. The Lancet. Respiratory Medicine 2020;
• 103 Barbaro RP, MacLaren G, Boonstra PS. et al. Extracorporeal membrane oxygenation support in COVID-19: an international cohort study of the Extracorporeal Life Support Organization registry. Lancet (London, England) 2020; 396: 1071-1078
• 104 Sedierung von Patienten mit COVID-19 in der Intensivmedizin. Addendum zur S3-Leitlinie Analgesie, Sedierung und Delirmanagement in der Intensivmedizin. AWMF-Registernummer: 001/012. 2020 in press.
• 105 Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin. S2k-Leitlinie Prolongiertes Weaning. 2019. https://www.awmf.org/leitlinien/detail/ll/020-015.html
• 106 McGrath BA, Brenner MJ, Warrillow SJ. et al. Tracheostomy in the COVID-19 era: global and multidisciplinary guidance. The Lancet. Respiratory Medicine 2020;
• 107 Griffiths RD, Hall JB. Intensive care unit-acquired weakness. Crit Care Me 2010; 38: 779-787
• 108 Wang R, Pan C, Wang X. et al. The impact of tracheotomy timing in critically ill patients undergoing mechanical ventilation: A meta-analysis of randomized controlled clinical trials with trial sequential analysis. Heart Lung 2019; 48: 46-54
• 109 Elkbuli A, Narvel RI, Spano PJ. et al. Early versus Late Tracheostomy: Is There an Outcome Difference?. Am Surg 2019; 85: 370-375
• 110 McGrath BA, Brenner MJ, Warrillow SJ. Tracheostomy for COVID-19: business as usual?. Br J Anaesth 2020;
• 111 Shao F, Xu S, Ma X. et al. In-hospital cardiac arrest outcomes among patients with COVID-19 pneumonia in Wuhan, China. Resuscitation 2020; 151: 18-23
• 112 Hayek SS, Brenner SK, Azam TU. et al. In-hospital cardiac arrest in critically ill patients with covid-19: multicenter cohort study. BMJ (Clinical research ed.) 2020; 371: m3513
• 113 Empfehlungen des International Liaison Committee on Resuscitation (ILCOR), des Europäischen Rates für Wiederbelebung (ERC) und des Deutschen Rates für Wiederbelebung/German Resuscitation Council (GRC) zur CPR bei Patienten mit COVID-19. 2020. https://www.grc-org.de/ueber-uns/aktuelles (letzter Zugriff 23.11.2020)
• 114 Böttiger BW, Wetsch WA. Pulmonary Embolism Cardiac Arrest: Thrombolysis During Cardiopulmonary Resuscitation and Improved Survival. Chest 2019; 156: 1035-1036
• 115 Wichmann D, Sperhake JP, Lütgehetmann M. et al. Autopsy Findings and Venous Thromboembolism in Patients With COVID-19. Ann Intern Med 2020;
• 116 Langer F, Kluge S, Klamroth R. et al. Coagulopathy in COVID-19 and Its Implication for Safe and Efficacious Thromboprophylaxis. Hamostaseologie 2020; 40: 264-269
• 117 Nadkarni GN, Lala A, Bagiella E. et al. Anticoagulation, Mortality, Bleeding and Pathology Among Patients Hospitalized with COVID-19: A Single Health System Study. Journal of the American College of Cardiology 2020;
• 118 Paranjpe I, Fuster V, Lala A. et al. Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients With COVID-19. J Am Coll Cardiol 2020; 76: 122-124
• 119 Treichl B, Bachler M, Lorenz I. et al. Efficacy of argatroban in critically ill patients with heparin resistance: a retrospective analysis. Semin Thromb Hemos 2015; 41: 61-67
• 120 McGlynn F, McGrath J, Varghese C. et al. Argatroban for therapeutic anticoagulation for heparin resistance associated with Covid-19 infection. J Thromb Thrombolysis 2020; 1-3
• 121 Connors JM, Levy JH. COVID-19 and its implications for thrombosis and anticoagulation. Blood 2020;
• 122 Fogarty H, Townsend L, Ni Cheallaigh C. et al. COVID19 coagulopathy in Caucasian patients. Br J Haematol 2020;
• 123 Brunkhorst FM, Weigand MA, Pletz M. et al. S3-Leitlinie Sepsis – Prävention, Diagnose, Therapie und Nachsorge – Langfassung. Medizinische Klinik, Intensivmedizin und Notfallmedizin 2020; 115 (Suppl. 02) 37-109
• 124 Bartoletti M, Pascale R, Cricca M. et al. Epidemiology of invasive pulmonary aspergillosis among COVID-19 intubated patients: a prospective study. Clin Infect Dis 2020;
• 125 Malin JJ, Spinner CD. DGI recommendations for COVID-19 pharmacotherapy. Infection 2020;
• 126 Siemieniuk R, Rochwerg B, Agoritsas T. et al. A living WHO guideline on drugs for covid-19. BMJ (Clinical research ed.). 2020; 370: m3379
• 127 Simonis A, Theobald SJ, Fätkenheuer G. et al. A comparative analysis of remdesivir and other repurposed antivirals against SARS-CoV-2. EMBO Mol Med 2020; e202013105
• 128 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the Treatment of Covid-19 – Preliminary Report. N Engl J Med 2020;
• 129 Beigel JH, Tomashek KM, Dodd LE. et al. Remdesivir for the Treatment of Covid-19 – Final Report. N Engl J Med 2020;
• 130 Goldman JD, Lye DCB, Hui DS. et al. Remdesivir for 5 or 10 Days in Patients with Severe Covid-19. N Engl J Med 2020;
• 131 Wang Y, Zhang D, Du G. et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet (London, England) 2020; 395: 1569-1578
• 132 Spinner CD, Gottlieb RL, Criner GJ. et al. Effect of Remdesivir vs Standard Care on Clinical Status at 11 Days in Patients With Moderate COVID-19: A Randomized Clinical Trial. JAMA 2020;
• 133 Pan H, Peto R, Henao-Restrepo AM. et al. Repurposed Antiviral Drugs for Covid-19 – Interim WHO Solidarity Trial Results. N Engl J Med 2020;
• 134 Williamson BN, Feldmann F, Schwarz B. et al. Clinical benefit of remdesivir in rhesus macaques infected with SARS-CoV-2. Nature 2020;
• 135 Cavalcanti AB, Zampieri FG, Rosa RG. et al. Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19. N Engl J Med 2020; 383: 2041-2052
• 136 Borba MGS, Val FFA, Sampaio VS. et al. Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection: A Randomized Clinical Trial. JAMA network open 2020; 3: e208857
• 137 Wang M, Cao R, Zhang L. et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus (2019-nCoV) in vitro. Cell Res 2020; 30: 269-271
• 138 Chen ZHJ, Zhang Z. et al. Efficacy of hydroxychloroquine in patients with COVID-19: results of a randomized clinical trial. medRxiv; 2020
• 139 Horby P, Mafham M, Linsell L. et al. Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19. N Engl J Med 2020;
• 140 Boulware DR, Pullen MF, Bangdiwala AS. et al. A Randomized Trial of Hydroxychloroquine as Postexposure Prophylaxis for Covid-19. N Engl J Med 2020; 383: 517-525
• 141 Furtado RHM, Berwanger O, Fonseca HA. et al. Azithromycin in addition to standard of care versus standard of care alone in the treatment of patients admitted to the hospital with severe COVID-19 in Brazil (COALITION II): a randomised clinical trial. Lancet (London, England) 2020; 396: 959-967
• 142 Hung IF, Lung KC, Tso EY. et al. Triple combination of interferon beta-1b, lopinavir-ritonavir, and ribavirin in the treatment of patients admitted to hospital with COVID-19: an open-label, randomised, phase 2 trial. Lancet (London, England) 2020;
• 143 WHO Solidarity trial consortium. Repurposed antiviral drugs for COVID-19 – interim WHO SOLIDARITY trial results. medRxiv (15.10.2020.) 2020.
• 144 Cao B, Wang Y, Wen D. et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19. N Engl J Med 2020; 382: 1787-1799
• 145 Lopinavir-ritonavir in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet (London, England) 2020;
• 146 Tsai MJ, Yang KY, Chan MC. et al. Impact of corticosteroid treatment on clinical outcomes of influenza-associated ARDS: a nationwide multicenter study. Ann Intensive Car 2020; 10: 26
• 147 Horby P, Lim WS, Emberson JR. et al. Dexamethasone in Hospitalized Patients with Covid-19 – Preliminary Report. N Engl J Med 2020;
• 148 Angus DC, Derde L, Al-Beidh F. et al. Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. JAMA 2020; 324: 1317-1329
• 149 Tomazini BM, Maia IS, Cavalcanti AB. et al. Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19: The CoDEX Randomized Clinical Trial. JAMA 2020;
• 150 Dequin PF, Heming N, Meziani F. et al. Effect of Hydrocortisone on 21-Day Mortality or Respiratory Support Among Critically Ill Patients With COVID-19: A Randomized Clinical Trial. JAMA 2020;
• 151 Sterne JAC, Murthy S, Diaz JV. et al. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA 2020;
• 152 WHO. Corticosteroids for COVID-19 – Living Guidance. https://www.who.int/publications/i/item/WHO-2019-nCoV-Corticosteroids-2020.1 (02.09.2020)
• 153 Colaneri M, Bogliolo L, Valsecchi P. et al. Tocilizumab for Treatment of Severe COVID-19 Patients: Preliminary Results from SMAtteo COvid19 REgistry (SMACORE). Microorganisms 2020; 8: 695
• 154 Luo P, Liu Y, Qiu L. et al. Tocilizumab treatment in COVID-19: A single center experience. J Med Virol 2020;
• 155 Stone JH, Frigault MJ, Serling-Boyd NJ. et al. Efficacy of Tocilizumab in Patients Hospitalized with Covid-19. N Engl J Med 2020;
• 156 Hermine O, Mariette X, Tharaux PL. et al. Effect of Tocilizumab vs Usual Care in Adults Hospitalized With COVID-19 and Moderate or Severe Pneumonia: A Randomized Clinical Trial. JAMA Intern Med 2020;
• 157 Salvarani C, Dolci G, Massari M. et al. Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. JAMA Intern Med 2020;
• 158 Gupta S, Wang W, Hayek SS. et al. Association Between Early Treatment With Tocilizumab and Mortality Among Critically Ill Patients With COVID-19. JAMA Intern Med 2020;
• 159 Cavalli G, De Luca G, Campochiaro C. et al. Interleukin-1 blockade with high-dose anakinra in patients with COVID-19, acute respiratory distress syndrome, and hyperinflammation: a retrospective cohort study. Lancet Rheumatol 2020; 2: e325-e331
• 160 Chai KL, Valk SJ, Piechotta V. et al. Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a living systematic review. Cochrane Database Syst Rev 2020; 10: Cd013600
• 161 Li L, Zhang W, Hu Y. et al. Effect of Convalescent Plasma Therapy on Time to Clinical Improvement in Patients With Severe and Life-threatening COVID-19: A Randomized Clinical Trial. JAMA 2020;
• 162 Salazar E, Christensen PA, Graviss EA. et al. Treatment of Coronavirus Disease 2019 Patients with Convalescent Plasma Reveals a Signal of Significantly Decreased Mortality. Am J Pathol 2020;
• 163 Pressemitteilung der Firma Lilly. Baricitinib in Combination with Remdesivir Reduces Time to Recovery in Hospitalized Patients with COVID-19 in NIAID-Sponsored ACTT-2 Trial. https://investor.lilly.com/node/43706/pdf (14.09.2020)
• 164 University of Liverpool. http://www.covid19-druginteractions.org (letzter Zugriff 23.11.2020)
• 165 Nachtigall I, Lenga P, Jóźwiak K. et al. Clinical course and factors associated with outcomes among 1904 patients hospitalized with COVID-19 in Germany: an observational study. Clin Microbiol Infect 2020;
• 166 Carfì A, Bernabei R, Landi F. Persistent Symptoms in Patients After Acute COVID-19. JAMA 2020; 324: 603-605
• 167 Hickie I, Davenport T, Wakefield D. et al. Post-infective and chronic fatigue syndromes precipitated by viral and non-viral pathogens: prospective cohort study. BMJ (Clinical research ed.) 2006; 333: 575
• 168 Vasarmidi E, Tsitoura E, Spandidos DA. et al. Pulmonary fibrosis in the aftermath of the COVID-19 era (Review). Exp Ther Med 2020; 20: 2557-2560
• 169 Rajpal S, Tong MS, Borchers J. et al. Cardiovascular Magnetic Resonance Findings in Competitive Athletes Recovering From COVID-19 Infection. JAMA cardiology 2020;
• 170 Glöckl R, Buhr-Schinner H, Koczulla AR. et al. [Recommendations from the German Respiratory Society for Pulmonary Rehabilitation in Patients with COVID-19]. Pneumologie 2020; 74: 496-504
• 171 Deutsche Gesellschaft für Neurorehabilitation e. V. (DGNR). S2k-Leitlinie SARS-CoV-2, COVID-19 und (Früh-) Rehabilitation. www.awmf.de (letzter Zugriff 23.11.2020)
• 172 Gudbjartsson DF, Helgason A, Jonsson H. et al. Spread of SARS-CoV-2 in the Icelandic Population. N Engl J Med 2020; 382: 2302-2315
• 173 Patel NA. Pediatric COVID-19: Systematic review of the literature. Am J Otolaryngol 2020; 41: 102573
• 174 Venn AMR, Schmidt JM, Mullan PC. A case series of pediatric croup with COVID-19. Am J Emerg Med 2020;
• 175 Dong Y, Mo X, Hu Y. et al. Epidemiology of COVID-19 Among Children in China. Pediatrics 2020; 145: e20200702
• 176 Tagarro A, Epalza C, Santos M. et al. Screening and Severity of Coronavirus Disease 2019 (COVID-19) in Children in Madrid, Spain. JAMA pediatrics 2020;
• 177 Whittaker E, Bamford A, Kenny J. et al. Clinical Characteristics of 58 Children With a Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2. JAMA 2020;
• 178 Riphagen S, Gomez X, Gonzalez-Martinez C. et al. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet (London, England) 2020; 395: 1607-1608
• 179 Ramcharan T, Nolan O, Lai CY. et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol 2020; 1-11
• 180 Verdoni L, Mazza A, Gervasoni A. et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet (London, England) 2020; 395: 1771-1778
• 181 Janssens U, Burchardi N, Duttge G. et al. Therapiezieländerung und Therapiebegrenzung in der Intensivmedizin. DIVI 2012; 3: 103-107
• 182 Deutsche Gesellschaft für Palliativmedizin. https://www.dgpalliativmedizin.de/category/178-stellungnahmen-2020.html (letzter Zugriff 23.11.2020)
• 183 Dutzmann J, Hartog C, Janssens U. et al. Entscheidungen über die Zuteilung intensivmedizinischer Ressourcen im Kontext der COVID-19-Pandemie. https://www.divi.de/register/aktuelle-informationen (letzter Zugriff 23.11.2020)