Abstract
Dear editor, we would like to share you our experience regarding the management of re-fractory hypoxemia, refractory hypotension and shock in critically ill Covid-19 patients. We believe that, one of the main causes of the deterioration of Covid-19 patients could be malnutrition with vitamins depletion from the body. Many of these patients presented with loss of appetite and taste accompanied with poor oral intake for several days or even weeks. This will deplete the body resources from Macro-& micro-nutrients especially thi-amine, which can be deficient in 3-14 days particularly if the patient is already malnour-ished, taking anti-thiamine products (as coffee, tea), receiving Total Parenteral Nutrition (TPN), on Continuous Renal Replacement Therapy (CRRT), or had a bariatric surgery. From the daily practice, we have noticed that refractory hypoxemia, refractory hypoten-sion, or septic shock is exaggerated by Thiamine deficiency. In the first wave of Covid-19 pandemic era, many patients were admitted in the ICUs with severe respiratory symptoms, deteriorated, became severely hypoxemic, intubated and maximally supported with oxygen; the inspired oxygen fraction (FiO2) was 100% for several days, diagnosed as severe stages of ARDS, ultimately, these patients passed away. Our observations have been emphasized when we admitted to our ICU a 33 years old pa-tient, with Body Mass Index (BMI) of 58 who remained severely hypoxemic (FiO2 100%) for about 9 days. We used all the means and resources to improve his oxygenation includ-ing Nitric oxide but we were unsuccessful. The process of deterioration started by develop-ing acute renal failure and treated with CRRT. Hemodynamically remained stable with 0.15 mcg/Kg/min of norepinephrine in the prone position 18 hours a day.