Covid-19 and Critical Care capacity: Can we mitigate demand?

The COVID-19 pandemic has placed unprecedenteddemand on modern healthcare resources. As such, there hasbeen much research and debate on how to best managepatients with COVID-19. Previous studies have shown thebenefits of neuromuscular blockade and prone positioningin the management of acute respiratory distress syndrome(ARDS),1as seen in COVID-19 pneumonitis,2while morerecent studies have explored the benefits of different medicaltreatments. These have included dexamethasone, sarilumaband tocilizumab as demonstrated by the RECOVERY3andREMAP-CAP trials.4None of these therapies have mitigatedthe demand for intensive care capacity which remains, atbest, extremely limited or more usually overwhelmed. Insuch circumstances, there is a need to predict which patientswith a significant oxygen dependency will avoid the need formechanical ventilation. Such patients could safely be caredfor in other parts of the hospital thereby preserving intensivecare unit capacity for mechanically ventilated patients.