J Korean Med Sci.  2022 Dec;37(49):e353. 10.3346/jkms.2022.37.e353.

How We Have Treated Severe to Critically Ill Patients With Coronavirus Disease 2019 in Korea

• Park DH
• Kang CK
• Choe PG
• Kim NJ
• Park WB
• Oh Md

• KMID: 2537047
• DOI: http://doi.org/10.3346/jkms.2022.37.e353

Abstract

Since 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, and the coronavirus disease 2019 (COVID-19) pandemic currently continues. In response to this unprecedented pandemic, several researchers and medical staff have struggled to find appropriate treatments for COVID-19. Patients with mild symptoms can recuperate with symptomatic care, however establishing treatment for severe to critically ill patients who can have a high mortality has been essential. Accordingly, the guidelines for COVID-19 treatment have evolved through numerous trials and errors and have been relatively well established to date. In the Republic of Korea, several evidence-based guidelines for COVID-19 treatment were released and revised, reflecting various research and regional medical conditions. To date, approximately 3 years after the beginning of the COVID-19 pandemic, we are reflecting on the changes in the guidelines thus far and have summarized the treatment experience of severe to critically ill patients with COVID-19. The Korean guidelines for COVID-19 treatment have been updated continuously as the National Institutes of Health (NIH) guidelines have changed. Dexamethasone is currently used as the backbone for the treatment of severe to critically ill patients with COVID-19, and remdesivir, baricitinib, and tocilizumab can be added depending on a patient’s situation. In addition, venous thromboembolism prophylaxis is one of the important adjunctive therapies for patients with severe COVID-19. In the clinical field, treatment of severely ill patients with COVID-19 based on guidelines is widely practiced by medical staff and established currently.

Keyword

Coronavirus disease 2019; Antiviral; Dexamethasone; Anticoagulation

Figure

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  Fig. 1 Timelines of recommended treatments for severe to critically ill patients with coronavirus disease 2019 according to Korean guidelines.LPV/r = lopinavir/ritonavir, PO = taken by mouth, IV = intravenous, G-CSF = granulocyte colony stimulating factor, IVIG = intravenous immunoglobulin, LMWH = low-molecular–weight heparin, UFH = unfractionated heparin.

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  Fig. 2 Comparisons between the NIH and Korean guidelines for treatments for severe to critically ill patients with coronavirus disease 2019 according to the time table.NIH = National Institutes of Health, LPV/r = lopinavir/ritonavir.

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  Fig. 3 Timelines of clinical practices regarding treatment for severe to critically ill patients with COVID-19 in Seoul National University Hospital.COVID-19 = coronavirus disease 2019, LPV/r = lopinavir/ritonavir, LMWH = low-molecular-weight heparin.

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