<?xml version="1.0" encoding="ISO-8859-1"?><article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance">
<front>
<journal-meta>
<journal-id>0016-3813</journal-id>
<journal-title><![CDATA[Gaceta médica de México]]></journal-title>
<abbrev-journal-title><![CDATA[Gac. Méd. Méx]]></abbrev-journal-title>
<issn>0016-3813</issn>
<publisher>
<publisher-name><![CDATA[Academia Nacional de Medicina de México A.C.]]></publisher-name>
</publisher>
</journal-meta>
<article-meta>
<article-id>S0016-38132020000300247</article-id>
<article-id pub-id-type="doi">10.24875/gmm.20000127</article-id>
<title-group>
<article-title xml:lang="es"><![CDATA[Recomendaciones de tratamiento para pacientes adultos graves con COVID-19]]></article-title>
<article-title xml:lang="en"><![CDATA[Recommendations for the management of critically ill adult patients with COVID-19]]></article-title>
</title-group>
<contrib-group>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Ñamendys-Silva]]></surname>
<given-names><![CDATA[Silvio A.]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
<xref ref-type="aff" rid="Aaf"/>
</contrib>
<contrib contrib-type="author">
<name>
<surname><![CDATA[Domínguez-Cherit]]></surname>
<given-names><![CDATA[Guillermo]]></given-names>
</name>
<xref ref-type="aff" rid="Aff"/>
</contrib>
</contrib-group>
<aff id="Af1">
<institution><![CDATA[,Instituto Nacional de Cancerología Departamento de Terapia Intensiva ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<aff id="Af2">
<institution><![CDATA[,Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán" Subdirección de Medicina Crítica ]]></institution>
<addr-line><![CDATA[Ciudad de México ]]></addr-line>
<country>México</country>
</aff>
<pub-date pub-type="pub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<pub-date pub-type="epub">
<day>00</day>
<month>06</month>
<year>2020</year>
</pub-date>
<volume>156</volume>
<numero>3</numero>
<fpage>247</fpage>
<lpage>249</lpage>
<copyright-statement/>
<copyright-year/>
<self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_arttext&amp;pid=S0016-38132020000300247&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_abstract&amp;pid=S0016-38132020000300247&amp;lng=en&amp;nrm=iso"></self-uri><self-uri xlink:href="http://www.scielo.org.mx/scielo.php?script=sci_pdf&amp;pid=S0016-38132020000300247&amp;lng=en&amp;nrm=iso"></self-uri><abstract abstract-type="short" xml:lang="es"><p><![CDATA[Resumen Con excepción de las mujeres embarazadas, el manejo de los pacientes adultos graves con COVID-19 durante la pandemia incluye los procedimientos estándar que se llevan a cabo en cualquier paciente que requiere atención en la unidad de cuidados intensivos, así como la administración limitada de las soluciones cristaloides, la intubación orotraqueal, la ventilación mecánica invasiva ante deterioro clínico del paciente y la relajación muscular en infusión continua solo cuando sea necesaria. No se recomienda la ventilación mecánica no invasiva, la oxigenoterapia de alto flujo debido a la generación de aerosol (asociado con riesgo de propagación del virus entre el personal de salud), la oxigenación por membrana extracorpórea ni el empleo de esteroides. Hasta el momento no hay tratamiento antiviral específico para pacientes con COVID-19 ni resultados de estudios controlados que avalen su uso.]]></p></abstract>
<abstract abstract-type="short" xml:lang="en"><p><![CDATA[Abstract 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.]]></p></abstract>
<kwd-group>
<kwd lng="es"><![CDATA[Coronavirus]]></kwd>
<kwd lng="es"><![CDATA[COVID-19]]></kwd>
<kwd lng="es"><![CDATA[Cuidados intensivos]]></kwd>
<kwd lng="es"><![CDATA[Terapia intensiva]]></kwd>
<kwd lng="en"><![CDATA[Coronavirus]]></kwd>
<kwd lng="en"><![CDATA[COVID-19]]></kwd>
<kwd lng="en"><![CDATA[Intensive care]]></kwd>
<kwd lng="en"><![CDATA[Critical care]]></kwd>
</kwd-group>
</article-meta>
</front><back>
<ref-list>
<ref id="B1">
<label>1</label><nlm-citation citation-type="book">
<collab>World Health Organization [sitio web]</collab>
<source><![CDATA[Coronavirus disease (COVID-2019) situation reports]]></source>
<year>2020</year>
<publisher-loc><![CDATA[Suiza ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B2">
<label>2</label><nlm-citation citation-type="journal">
<collab>The novel coronavirus pneumonia emergency response epidemiology team</collab>
<article-title xml:lang=""><![CDATA[The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19)-China]]></article-title>
<source><![CDATA[Zhonghua Liu Xing Bing Xue Za Zhi]]></source>
<year>2020</year>
<volume>2</volume>
<page-range>113-22</page-range></nlm-citation>
</ref>
<ref id="B3">
<label>3</label><nlm-citation citation-type="book">
<source><![CDATA[Secretaría de Salud de México [sitio web]. Comunicado técnico diario nuevo coronavirus en el mundo (COVID-19)]]></source>
<year>2020</year>
<publisher-loc><![CDATA[México ]]></publisher-loc>
<publisher-name><![CDATA[SSa]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B4">
<label>4</label><nlm-citation citation-type="book">
<collab>World Health Organization</collab>
<source><![CDATA[Clinical management of severe acute respiratory infection when COVID-19 is suspected]]></source>
<year>2020</year>
<publisher-loc><![CDATA[Suiza ]]></publisher-loc>
<publisher-name><![CDATA[WHO]]></publisher-name>
</nlm-citation>
</ref>
<ref id="B5">
<label>5</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Rhodes]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Evans]]></surname>
<given-names><![CDATA[LE]]></given-names>
</name>
<name>
<surname><![CDATA[Alhazzani]]></surname>
<given-names><![CDATA[W]]></given-names>
</name>
<name>
<surname><![CDATA[Levy]]></surname>
<given-names><![CDATA[MM]]></given-names>
</name>
<name>
<surname><![CDATA[Antonelli]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Ferrer]]></surname>
<given-names><![CDATA[R]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Surviving sepsis campaign:international guidelines for management of sepsis and septic shock:2016]]></article-title>
<source><![CDATA[Intensive Care Med]]></source>
<year>2017</year>
<volume>43</volume>
<page-range>304-77</page-range></nlm-citation>
</ref>
<ref id="B6">
<label>6</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Cheung]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Ho]]></surname>
<given-names><![CDATA[LT]]></given-names>
</name>
<name>
<surname><![CDATA[Cheng]]></surname>
<given-names><![CDATA[JV]]></given-names>
</name>
<name>
<surname><![CDATA[Cham]]></surname>
<given-names><![CDATA[EYK]]></given-names>
</name>
<name>
<surname><![CDATA[Lam]]></surname>
<given-names><![CDATA[KN]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Staff safety during emergency airway management for COVID-19 in Hong Kong]]></article-title>
<source><![CDATA[Lancet Respir Med]]></source>
<year>2020</year>
<volume>8</volume>
<page-range>e19</page-range></nlm-citation>
</ref>
<ref id="B7">
<label>7</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ranieri]]></surname>
<given-names><![CDATA[VM]]></given-names>
</name>
<name>
<surname><![CDATA[Rubenfeld]]></surname>
<given-names><![CDATA[GD]]></given-names>
</name>
<name>
<surname><![CDATA[Thompson]]></surname>
<given-names><![CDATA[BT]]></given-names>
</name>
<name>
<surname><![CDATA[Ferguson]]></surname>
<given-names><![CDATA[ND]]></given-names>
</name>
<name>
<surname><![CDATA[Caldwell]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[ARDS Definition Task Force, Acute respiratory distress syndrome:The Berlin Definition]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2012</year>
<volume>307</volume>
<page-range>2526-33</page-range></nlm-citation>
</ref>
<ref id="B8">
<label>8</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Guérin]]></surname>
<given-names><![CDATA[C]]></given-names>
</name>
<name>
<surname><![CDATA[Reignier]]></surname>
<given-names><![CDATA[J]]></given-names>
</name>
<name>
<surname><![CDATA[Richard]]></surname>
<given-names><![CDATA[JC]]></given-names>
</name>
<name>
<surname><![CDATA[Beuret]]></surname>
<given-names><![CDATA[P]]></given-names>
</name>
<name>
<surname><![CDATA[Gacouin]]></surname>
<given-names><![CDATA[A]]></given-names>
</name>
<name>
<surname><![CDATA[Mercier]]></surname>
<given-names><![CDATA[E]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Prone positioning in severe acute respiratory distress syndrome]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2013</year>
<volume>368</volume>
<page-range>2159-68</page-range></nlm-citation>
</ref>
<ref id="B9">
<label>9</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Moss]]></surname>
<given-names><![CDATA[M]]></given-names>
</name>
<name>
<surname><![CDATA[Huang]]></surname>
<given-names><![CDATA[DT]]></given-names>
</name>
<name>
<surname><![CDATA[Brower]]></surname>
<given-names><![CDATA[RG]]></given-names>
</name>
<name>
<surname><![CDATA[Ferguson]]></surname>
<given-names><![CDATA[ND]]></given-names>
</name>
<name>
<surname><![CDATA[Ginde]]></surname>
<given-names><![CDATA[AA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[The National Heart, Lung, and Blood Institute PETAL Clinical Trials Network, Early neuromuscular blockade in the acute respiratory distress syndrome]]></article-title>
<source><![CDATA[N Engl J Med]]></source>
<year>2019</year>
<volume>380</volume>
<page-range>1997-2008</page-range></nlm-citation>
</ref>
<ref id="B10">
<label>10</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Ñamendys-Silva]]></surname>
<given-names><![CDATA[SA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Respiratory support for patients with COVID-19 infection]]></article-title>
<source><![CDATA[Lancet Respir Med]]></source>
<year>2020</year>
<volume>S2213-2600</volume>
<page-range>30110-7</page-range></nlm-citation>
</ref>
<ref id="B11">
<label>11</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Murthy]]></surname>
<given-names><![CDATA[S]]></given-names>
</name>
<name>
<surname><![CDATA[Gomersall]]></surname>
<given-names><![CDATA[CD]]></given-names>
</name>
<name>
<surname><![CDATA[Fowler]]></surname>
<given-names><![CDATA[RA]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Care for critically ill patients with COVID-19]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>10</volume>
<page-range>1001</page-range></nlm-citation>
</ref>
<ref id="B12">
<label>12</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[MacLaren]]></surname>
<given-names><![CDATA[G]]></given-names>
</name>
<name>
<surname><![CDATA[Fisher]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
<name>
<surname><![CDATA[Brodie]]></surname>
<given-names><![CDATA[D]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Preparing for the most critically ill patients with COVID-19:the potential role of extracorporeal membrane oxygenation]]></article-title>
<source><![CDATA[JAMA]]></source>
<year>2020</year>
<volume>10</volume>
<page-range>1001</page-range></nlm-citation>
</ref>
<ref id="B13">
<label>13</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Brandon]]></surname>
<given-names><![CDATA[MH]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[COVID-19, ECMO, and lymphopenia:a word of caution]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2020</year>
<volume>8</volume>
<page-range>24</page-range></nlm-citation>
</ref>
<ref id="B14">
<label>14</label><nlm-citation citation-type="journal">
<person-group person-group-type="author">
<name>
<surname><![CDATA[Russell]]></surname>
<given-names><![CDATA[CD]]></given-names>
</name>
<name>
<surname><![CDATA[Millar]]></surname>
<given-names><![CDATA[JE]]></given-names>
</name>
<name>
<surname><![CDATA[Baillie]]></surname>
<given-names><![CDATA[JK]]></given-names>
</name>
</person-group>
<article-title xml:lang=""><![CDATA[Clinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury]]></article-title>
<source><![CDATA[Lancet]]></source>
<year>2020</year>
<volume>395</volume>
<page-range>473-5</page-range></nlm-citation>
</ref>
</ref-list>
</back>
</article>
