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Although the majority of COVID-19 cases are self-limiting, a substantial minority of patients develop disease severe enough to require intensive care. Features of critical illness associated with COVID-19 include hypoxemic respiratory failure, acute respiratory distress syndrome (ARDS), shock, and multiple organ dysfunction syndrome (MODS). In most (but not all) respects critically ill patients with COVID-19 resemble critically ill patients with ARDS due to other causes and are optimally managed with standard, evidence-based critical care protocols. However, there is naturally an intense interest in developing specific therapies for severe COVID-19. Here we synthesize the rapidly expanding literature around the pathophysiology, clinical presentation, and management of COVID-19 with a focus on those points most relevant for intensivists tasked with caring for these patients. We specifically highlight evidence-based approaches that we believe should guide the identification, triage, respiratory support, and general ICU care of critically ill patients infected with SARS-CoV-2. In addition, in light of the pressing need and growing enthusiasm for targeted COVID-19 therapies, we review the biological basis, plausibility, and clinical evidence underlying these novel treatment approaches.<\/jats:p>","DOI":"10.1177\/0885066620969132","type":"journal-article","created":{"date-parts":[[2020,10,28]],"date-time":"2020-10-28T05:55:00Z","timestamp":1603864500000},"page":"18-41","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":8,"title":["Evidence-Based Management of the Critically Ill Adult With SARS-CoV-2 Infection"],"prefix":"10.1177","volume":"36","author":[{"given":"Raghu R.","family":"Chivukula","sequence":"first","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Whitehead Institute for Biomedical Research, Cambridge, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason H.","family":"Maley","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9363-9345","authenticated-orcid":false,"given":"David M.","family":"Dudzinski","sequence":"additional","affiliation":[{"name":"Corrigan Minehan Heart Center, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA"},{"name":"Cardiac Intensive Care Unit, Division of Cardiology, Department of Medicine, Massachusetts General, Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Hibbert","sequence":"additional","affiliation":[{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4074-0420","authenticated-orcid":false,"given":"C. 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