Post-Intubation Empirical Fluid Resuscitation as an Early Step to Prevent Acute Kidney Injury in Mechanically Ventilated COVID-19 Patient

Acute Kidney Injury (AKI) is one of the major complication of the Coronavirus Disease 2019 (COVID-19) infection, commonly manifested during the second week of infection. The pathophysiology and mechanisms of AKI in patients with COVID-19 have not been fully elucidated and seem to be multifactorial. There is currently no common consensus regarding the optimal amount of fluid resuscitation specifically for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients in shock. There is paucity of knowledge regarding prevention of post-intubation hypotension and oliguria in COVID-19 patients. We suggest fluid resuscitation by 1 L of crystalloid immediately following endotracheal intubation of adult COVID ARDS patients to compensate vasodilation and improve renal perfusion. Conservative fluid strategies should be followed in patient having history of congestive heart failure, chronic kidney disease, adrenal insufficiency and in patient who have already developed AKI with oliguric phase.