Gac Med Mex
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The COVID-19 pandemic, which started in China, has spread rapidly to affect the entire world in a matter of months. Main manifestations of the disease include a febrile syndrome accompanied by respiratory symptoms; however, cases of systemic involvement are increasingly being reported, including cardiac and central nervous system compromise. In the series by Ling M. et al., 214 patients with COVID-19 were studied; 78 (36.4 %) had neurologic manifestations, which were classified into four main groups: acute cerebrovascular disease, impaired consciousness, peripheral nervous system involvement and muscular manifestations. Another report published by Li et al. describes that, out of 221 patients with COVID-19, 13 developed acute cerebrovascular disease with cerebral infarction, venous thrombosis and intracerebral hemorrhage.
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By April 2, 2020, only 116 days after the description of the first case of SARS-CoV2 virus infection, which causes the COVID-19 disease, 1,014,673 cases and 50,030 deaths have been recorded in 181 countries.1 In the United States, there have been 244,678 cases and 5,911 deaths recorded (in New York State alone, there are 93,053 cases and 2,538 deaths), while in Mexico, 1,378 cases and 37 deaths have been recorded. This number is expected to keep on increasing in both countries. The health system in Mexico, as well as in the rest of the world, will face an enormous problem in the months to come.
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Except for pregnant women, the management of critically ill patients with COVID-19 during the pandemic includes the standard procedures that are used for any patient that requires to be attended to at the intensive care unit, as well as limited administration of crystalloid solutions, orotracheal intubation, invasive mechanical ventilation in the event of patient clinical deterioration, and muscle relaxants continuous infusion only if necessary. Non-invasive mechanical ventilation and high-flow oxygen therapy are not recommended due to the generation of aerosol (associated with risk of viral spread among health personnel), and neither is extracorporeal membrane oxygenation or the use of steroids. So far, there is no specific antiviral treatment for patients with COVID-19, and neither are there results of controlled trials supporting the use of any.
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As of March 23, 2020, suspension of non-essential activities was declared in Mexico throughout the country in order to mitigate the spread of the COVID-19 pandemic. ⋯ In Mexico, social distancing is being applied, but studies are still required on the dynamics of the epidemic, person-to-person transmission, incidence of subclinical infections, and patient survival.
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Simultaneous mechanical ventilation of several patients with a single ventilator might reduce the deficit of these devices for the care of patients with acute respiratory failure due to Covid-19. ⋯ Simultaneous mechanical ventilation should be implemented by medical personnel with experience in the procedure, be restricted to two patients and carried out in the intensive care unit.