Clinical management of severe acute respiratory infections
when novel coronavirus is suspected: What to do and what not to do
Introduction 2
Section 1. Early recognition and management 3
Section 2. Management of severe respiratory distress, hypoxemia and ARDS 6
Section 3. Management of septic shock 8
Section 4. Prevention of complications 9
References 10
Acknowledgements
The emergence of novel coronavirus in 2012 (see http://www.who.int/csr/disease/coronavirus_infections/en/index.
html for the latest updates) has presented challenges for clinical management.
Pneumonia has been the most common clinical presentation; five patients developed Acute Respiratory Distress Syndrome (ARDS). Renal failure, pericarditis and disseminated intravascular coagulation
(DIC) have also occurred.
Our knowledge of the clinical features of coronavirus infection is limited and no virus-specific prevention or treatment (e.g. vaccine or antiviral drugs) is available. Thus, this interim guidance document
aims to help clinicians with supportive management of patients who have acute respiratory failure and
septic shock as a consequence of severe infection. Because other complications have been seen (renal
failure, pericarditis, DIC, as above) clinicians should monitor for the development of these and other
complications of severe infection and treat them according to local management guidelines.
As all confirmed cases reported to date have occurred in adults, this document focuses on the care of
adolescents and adults. Paediatric considerations will be added later.
This document will be updated as more information becomes available and after the revised Surviving
Sepsis Campaign Guidelines are published later this year (1).
This document is for clinicians taking care of critically ill patients with severe acute respiratory infection (SARI). It will be helpful if you work in an Intensive Care Unit (ICU) that has limited resources –
i.e. limited access to mechanical ventilation, invasive hemodynamic monitoring and arterial blood gas
analyzers – or if you have limited access to specialty training. It is not meant to replace clinical training
or specialist consultation but rather to strengthen your current clinical management of SARI and link
you to the most up-to-date guidance.
This document is organized into four sections, which correspond to clinical management steps. Section1
focuses on the early recognition and management of patients with SARI and includes early initiation of
supportive and infection prevention and control measures, and therapeutics. Section 2 focuses on management of patients who deteriorate and develop severe respiratory distress and ARDS. Section 3 focuses
on the management of patients who deteriorate and develop septic shock. Section 4 focuses on ongoing
care of the critically ill patient and best practices to prevent complications.
Three symbols are used: j
Do: the intervention is known to be beneficial.
h Don’t: the intervention is known to be harmful.
fBe careful when considering this intervention.
The recommendations in this document are derived mainly from evidence-based guidelines that WHO
has published, including the WHO Integrated Management of Adolescent and Adult Illness (IMAI) District Clinician Manual (2). Where WHO guidance is not available, we have used widely accepted global
consensus statements, such as guidelines of the Surviving Sepsis Campaign, and the results of recently
published randomized controlled trials. The recommendations have also been reviewed by a WHO
global network of clinicians (see Acknowledgements for names and affiliations).
Links are given here to additional sources and evidence. If you have further questions, contact us by
e-mail to outbreak@who.int with ‘Novel coronavirus clinical question’ in the subject line.
This interim guidance document will expire in 12 months from the date of publication...
