Outcome of COVID-19 associated severe ARDS: A case series

ICU course may be prolonged in patients suffering from Coronavirus associated acute respiratory distress syndrome (CARDS) due to severity of initial disease and presence of opportunistic infections. A structured approach to management may help reduce morbidity and mortality. Case presentation: We present a series of five cases of CARDS with a prolonged ICU course, despite the resolution of viremia. A multipronged therapeutic approach was adopted in the form of self proning, thrombo-prophylaxis, chest physiotherapy, adequate nutrition, psychotherapy and early mobilization. We could transfer two patients on domiciliary oxygen therapy and one on room air. Despite aggressive measures to control infection, one patient developed fungal sepsis, and another developed pseudomonal pneumonia. Both the patients rapidly deteriorated and succumbed to secondary infection, despite having shown initial recovery from CARDS. Conclusion: Prevention of infections is the key to recovery after resolution of viremia. This warrants COVID step down facility and structured rehabilitation program.