Protocol of mechanical ventilation and prevention of complications in critical care of patients with COVID-19: First version for Serbia

In December 2019, a new Corona virus (SARS-CoV-2) was identified as responsible for outbreak of viral pneumonia in Wuhan, Hubei Province, China. The World Health Organization has announced a pandemic of COVID-19 (Coronavirus disease 2019) on March 2nd 2020. COVID-19 is a respiratory infection where majority of patients have mild clinical symptoms. About 14% of patients require hospitalization and oxygen therapy and 5% of patients require admission to the intensive care unit. The most severe clinical cases include ARDS, sepsis and septic shock, acute renal failure, multiorgan dysfunction, and myocardial damage. Spread of the infection so far indicates that the number of patients requiring hospital admition and intensive care treatment will significantly burden the health care system in all countries. Several intensive and critical care protocols, based on the first experiences in treatment of viral pneumonia and severe COVID-19 illness, have already been published. Here we present the first version of a suggested protocol in our country, with an attached flowchart for the initial management of the COVID-19 patients in need for mechanical ventilation. The protocol is based on the worldwide existing experience in treatment of COVID-19 patients. The intention is not to replace the clinical experience and critical judgment of the attending doctors, but to strengthen their decisions and tailor treatment according to the recourses existing in our country.