Stephanie MaximousBrian Jason BrothertonAndrew AchilleosKevan M. AkramiLia M. BarrosNatalie CobbDavid MisangoAlfred PapaliCasey ParkVarun U. ShettyMarcus J. SchultzShaurya TaranBurton W. LeeUniversity of Washington Medical CenterUniversity of California, San DiegoSunnybrook Health Sciences CentreUniversidade Federal da BahiaMahidol UniversityUniversity of Pittsburgh Medical CenterNational Institutes of Health (NIH)Amsterdam UMC - University of AmsterdamKijabe Medical CenterInterdepartmental Division of Critical Care MedicineAga Khan University HospitalDivision of Pulmonary and Critical Care Medicine2022-08-042022-08-042021-03-01American Journal of Tropical Medicine and Hygiene. Vol.104, No.3 (2021), 72-8614761645000296372-s2.0-85103282474https://repository.li.mahidol.ac.th/handle/20.500.14594/77310As some patients infected with the novel coronavirus progress to critical illness, a subset will eventually develop shock. High-quality data on management of these patients are scarce, and further investigation will provide valuable information in the context of the pandemic. A group of experts identify a set of pragmatic recommendations for the care of patients with SARS-CoV-2 and shock in resource-limited environments. We define shock as life-threatening circulatory failure that results in inadequate tissue perfusion and cellular dysoxia/hypoxia, and suggest that it can be operationalized via clinical observations. We suggest a thorough evaluation for other potential causes of shock and suggest against indiscriminate testing for coinfections. We suggest the use of the quick Sequential Organ Failure Assessment (qSOFA) as a simple bedside prognostic score for COVID-19 patients and point-of-care ultrasound (POCUS) to evaluate the etiology of shock. Regarding fluid therapy for the treatment of COVID-19 patients with shock in low-middle–income countries, we favor balanced crystalloids and recommend using a conservative fluid strategy for resuscitation. Where available and not prohibited by cost, we recommend using norepinephrine, given its safety profile. We favor avoiding the routine use of central venous or arterial catheters, where availability and costs are strong considerations. We also recommend using low-dose corticosteroids in patients with refractory shock. In addressing targets of resuscitation, we recommend the use of simple bedside parameters such as capillary refill time and suggest that POCUS be used to assess the need for further fluid resuscitation, if available.Mahidol UniversityImmunology and MicrobiologyMedicineArticleSCOPUS10.4269/ajtmh.20-1105