Can you elaborate on what else is done to treat those patients? I was under the assumption that the pandemic situation is caused by a virus and that not much can be done against a virus besides waiting for the body to heal itself.
(Which is not entirely true, since AIDS can be treated nowadays.)
You’re correct there’s not a lot to be done for the virus itself - in that situation, care tends to become about protecting the various organs suffering in the process, to get the patient through it.
For example: a patient presents with acute respiratory distress and sepsis due to the flu, covid, whatever. The fluid in the lungs will be creating a burden on the heart; the general inflammation will be pissing off everything, including making blood vessels both leaky and dilated.
The burdened heart is now prone to being overtaxed. With leaky vessels, it’s also prone to being under supplied. And oxygen isn’t coming across the lungs well. A mismatch between its blood/oxygen supply and demands causes what’s called a demand ischemia - you can think of it as a kind of heart attack. This further weakens the heart.
This shortage of both supplied blood, and oxygen in the blood, plus systemic inflammation, can hit every other organ: kidney, liver, gut, etc.
This is where you can start to see some shock liver kick in. Which means one of our core mechanisms for metabolizing drugs (and everything else) is telling us to fuck off.
The same shock effect can hit kidneys. Reduced perfusion not only hurts kidneys, but means waste dumping into urine is being decreased, or not happening. We try to prop up kidney function. We also add fluids to try and increase perfusion (but if we have had an ischemia, the same bulk of fluid that is needed to maintain perfusion pressure can also act as a burden on a weakened heart.)
If the gut goes significantly ischemic, it can die. Even if it doesn’t die, local inflammation and reduced food intake can make it leaky. You’re not necessarily seeding bacteria into the blood that way (studies of pancreatitis w associated sepsis suggest that’s not a major contributor), but the gut associated lymphoid tissue is definitely going to be kicking into high gear and promoting our inflammation storm even more.
So, we try to carefully maintain perfusion, which involves monitoring and calibrating our support for heart, kidney, lung, etc. in an ongoing and dynamic fashion. And not uncommonly, besting down infections that develop along the way, because a bunch of plastic in the body is a badness.
I don’t work much in the ICU, so if I’ve misrepresented something and we have an intensivist on hand, I defer to them.
