Among patients hospitalized with coronavirus disease 2019 (COVID-19), up to one-quarter require intensive care unit (ICU) admission.

Profound hypoxemic respiratory failure from acute respiratory distress syndrome (ARDS) is the dominant finding in critically ill patients. Common complications include acute kidney injury (AKI), elevated liver enzymes, and the late development of cardiac injury, including sudden cardiac death. Sepsis, shock, and multi-organ failure are less common.

For most critically ill patients with COVID-19, we prefer the lowest possible fraction of inspired oxygen (FiO2) necessary to meet oxygenation goals, ideally targeting a peripheral oxygen saturation between 90 and 96 percent.

For critically ill patients with COVID-19, intubation should not be delayed until the patient acutely decompensates since this is potentially harmful to both the patient and healthcare workers. We have a low threshold to intubate those who have.

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