COVID Disease — Recommended Laboratory Studies for Critically Ill Patients — Clinical Pathway: All Settings

Active COVID-19, Clinical Pathway — All Settings

Recommended Laboratory/Imaging Studies

Labs/Imaging by Illness Severity
Mild
Upper respiratory tract disease		 None routinely recommended
Moderate
Lower respiratory tract disease, no supplemental oxygen requirement		 Consider chest x-ray
CMP as clinically indicated (e.g., concern for dehydration)
Severe
Supplemental oxygen requirement or SpO2 < 94% on room air		 Chest x-ray
CBC with differential, CMP, PT/PTT
As clinically indicated: CRP, procalcitonin, pregnancy test, type and screen
Critical
Requiring invasive or non-invasive mechanical ventilation (including HFNC) or ECMO		 CBC with differential, CMP, PT/PTT, fibrinogen, D-Dimer, blood gas
As clinically indicated: CRP, procalcitonin, pregnancy test, type and screen, proinflammatory cytokine panel

Obtain Proinflammatory Cytokine Panel as clinically indicated

Proinflammatory Cytokine Panel

Includes IFNg, IL-1b, IL-10, IL-12p70, IL-13, IL-2, IL-4, IL-6, IL-8, TNFa

  • Cytokine testing is not needed on every patient admitted to the PICU with COVID-19, only those with suspected refractory hyperinflammation
  • Consider DIRT consult if sending a cytokine panel and if a cytokine panel is needed urgently.

Ordering the Proinflammatory Cytokine Panel

  • Order proinflammatory cytokine panel (in house test).
    • Do NOT order cytokine panel 12 (send out test).
  • Routine Process
    • Performed routinely Tuesday through Thursday
    • Samples in lab by 9 AM are run that day
    • Can collect overnight and store in central receiving
  • STAT Testing
    • Can be performed same day if results needed for critically ill pt, where results may inform best immunomodulator
    • Discuss with DIRT APP and/or rheumatology to facilitate this testing
  • Specimen
    • Collect 1 mL in lithium heparin MINT GREEN-top tube
    • NOT dark green-top tube