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Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerged as a pandemic, affected millions of people and continues to spread across the globe. While knowledge about the disease is evolving, there are still uncertainties surrounding pathophysiology of severe form of the disease and optimal management strategies. Severe pulmonary disease is characterized by sepsis, acute respiratory distress syndrome, and respiratory failure. In these hospitalized patients, acquired volume overload remains an obvious risk of aggressive fluid resuscitation and the impact of interstitial edema and congestion on the functioning of other organ systems like the kidney and the lungs are detrimental.

Case Description: In this case series, we have included six patients who were admitted to the intensive care unit (ICU) with coronavirus disease 2019 (COVID-19) pneumonia complicated by volume overload. All six patients had persistent hypoxemia requiring extracorporeal membrane oxygenation (ECMO) and volume overload. Slow continuous ultrafiltration (SCUF) was utilized for controlled volume management for both patients in positive volume status despite being on loop diuretics and patients who had robust urine output causing negative pressure on the ECMO. Out of the six, three patients had reduced length of stay in the ICU, shorter period of SCUF (7–8 days) with no major complications.

Conclusions: This case series is aimed to understand the magnanimity of volume overload in hospitalized COVID patients and approach to management by utilizing slow continuous ultrafiltration.