Table 3 Detailed case vignette for Case 1 (translated from German)

CASE 1

You are caring for the 67-year-old retired bus driver Johann Perler (110 kg, 187 cm) suffering from a COVID-19 infection

Airway: intubated 8 days ago due to ARDS, difficult intubation

Breathing: FiO2 90%, Pinsp 30 cmH2O, PEEP 15 cmH2O, intermittent prone positioning

Circulation: Shock (low-grade therapy with Norepinephrine), intermittent atrial fibrillation and irregular supraventricular tachycardia requiring cardioversion once

Disability: none, RASS -5 due to sedation

Exposure: central line, arterial cannula, endotracheal tube

Signs & Symptoms:

Onset of symptoms 14 days ago with high fever, infection via his spouse, admitted 8 days ago to ICU with respiratory distress due to ARDS

Allergies: none

Medication: Chronic prescription: Valsartan and acetylic acid. Medication in ICU: propofol, sufentanil, piperacillin/tazobactam, pantoprazol, enoxaparine low dose

Past Medical History: thromboembolic stroke 5 years ago, carotis disobliteration 5 years ago, smoker (50 pack years)

Last Meal: enteral feeding via nasogastric tube

Events: none

Chest CT:

Opaque infiltrations in both lungs, basal atelectasis, unknown mass in the right upper lobe

Echocardiography: sufficient left-ventricular function, dyskinesia of the anterior wall

ABG: pH 7.4, pO2 67 mmHg, pCO2 45 mmHg, SaO2 95%, Na 140 mmol/l K 4,5 mmol/l,

lactate 1,7 mmol/l

Blood Sample Test: WBC 6,7 cells/mm³, Hb 13,4 g/dl, Platelets 515,000/mm³

Serum: Creatinine 2.4 mg/dl, AST 67 U/l ALT 77 U/L, GGT 123 U/l, Bilirubin 1.2 mg/dl, C-reactive protein 24 mg/dl, Procalcitonin 3.4 pg/ml

Patient will: unknown

Family: Full Therapy

Plan: stabilize oxygenation, obtain informed consent for tracheostomy, nephrology consultation