As the coronavirus disease 2019 (COVID-19) pandemic spreads across the globe, the intensive care unit (ICU) care management must brace for the problems that come with it. Patients with COVID-19, as well as healthcare professionals and other patients at risk of nosocomial transmission, can benefit from streamlining workflows for rapid diagnosis and isolation, clinical management, and infection prevention. Acute respiratory failure and hemodynamics must be managed carefully. ICU practitioners, hospital management, states, and policymakers must plan for a significant increase in critical care bed size, focusing not only on facilities and equipment but also on patient safety.  Critical care triage to allow the rationing of scarce ICU resources might be needed. Researchers must address unanswered questions, including the role of repurposed and experimental therapies. Collaboration at the local, regional, national, and international levels offers the best chance of survival for the critically ill.

ICU management is not without its difficulties. Through centuries of treating the victims of wars, epidemics, and natural disasters, the whole concept of concentrating medical staff and isolating the sickest patients in one region for more intensive monitoring and care was created. Given the exponential increase in the number of areas with community transmission around the world, as well as the significant risk of missing cases early in a local outbreak, ICU practitioners should have a high index of suspicion and a low threshold for diagnostic testing for any patient with a serious acute respiratory infection, if available.

Maintaining an intensive care unit (ICU) and delivering intensive care to all patients who benefit from it requires a significant investment in staff, technology, and material resources within a limited period of time, which is naturally correlated with costs. Managing intensive care resources is difficult due to the complexities of the care systems involved and the fluctuation of the number of patients requiring intensive care at any given time. Having too many resources can be costly and lead to inefficient use of ICU beds, while having too few resources prevents timely admission of patients, raises the likelihood of bad results, and can, paradoxically, raise costs by unnecessarily prolonging patients’ stay in the ICU. The most effective resource utilization and enhanced results can be achieved by optimizing the entire patient care process, including the pre-ICU, ICU, and post-ICU phases.