Patients admitted to the ICU with critical COVID-19 often require prolonged periods of mechanical ventilation. Difficulty weaning, lack of progress, and clinical deterioration are commonly encountered. These conditions should prompt a thorough evaluation for persistent or untreated manifestations of COVID-19, as well as complications from COVID-19 and its various treatments. Inflammation may persist and lead to fibroproliferative changes in the lungs. Infectious complications may arise including bacterial superinfection in the earlier stages of disease. Use of immunosuppressants may lead to the dissemination of latent infections, and to opportunistic infections. Venous thromboembolic disease is common, as are certain neurologic manifestations of COVID-19 including delirium and stroke. High levels of ventilatory support may lead to ventilator-induced injury to the lungs and diaphragm. We present diagnostic and therapeutic considerations for the mechanically ventilated patient with COVID-19 who shows persistent or worsening signs of critical illness, and we offer an approach to treating this complex but common scenario.

因重症 COVID-19 入住 ICU 的患者通常需要长时间的机械通气。通常会遇到脱机困难、进展缓慢和临床恶化。这些情况应促使对 COVID-19 的持续或未经治疗的表现，以及 COVID-19 及其各种治疗的并发症进行全面评估。炎症可能持续存在并导致肺部纤维增生性改变。可能会出现感染性并发症，包括疾病早期的细菌二重感染。使用免疫抑制剂可能导致潜伏感染的传播和机会性感染。静脉血栓栓塞性疾病很常见，COVID-19 的某些神经系统表现也很常见，包括谵妄和中风。高水平的通气支持可能导致呼吸机引起的肺部和膈肌损伤。我们提出了对机械通气 COVID-19 患者的诊断和治疗注意事项，这些患者表现出持续或恶化的危重病征象，并且我们提供了一种治疗这种复杂但常见情况的方法。