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1.
Crit Care Med ; 49(11): 1974-1982, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1475880
2.
Crit Care ; 25(1): 128, 2021 04 06.
Article in English | MEDLINE | ID: covidwho-1169981

ABSTRACT

BACKGROUND: Limited data are available on the use of prone position in intubated, invasively ventilated patients with Coronavirus disease-19 (COVID-19). Aim of this study is to investigate the use and effect of prone position in this population during the first 2020 pandemic wave. METHODS: Retrospective, multicentre, national cohort study conducted between February 24 and June 14, 2020, in 24 Italian Intensive Care Units (ICU) on adult patients needing invasive mechanical ventilation for respiratory failure caused by COVID-19. Clinical data were collected on the day of ICU admission. Information regarding the use of prone position was collected daily. Follow-up for patient outcomes was performed on July 15, 2020. The respiratory effects of the first prone position were studied in a subset of 78 patients. Patients were classified as Oxygen Responders if the PaO2/FiO2 ratio increased ≥ 20 mmHg during prone position and as Carbon Dioxide Responders if the ventilatory ratio was reduced during prone position. RESULTS: Of 1057 included patients, mild, moderate and severe ARDS was present in 15, 50 and 35% of patients, respectively, and had a resulting mortality of 25, 33 and 41%. Prone position was applied in 61% of the patients. Patients placed prone had a more severe disease and died significantly more (45% vs. 33%, p < 0.001). Overall, prone position induced a significant increase in PaO2/FiO2 ratio, while no change in respiratory system compliance or ventilatory ratio was observed. Seventy-eight % of the subset of 78 patients were Oxygen Responders. Non-Responders had a more severe respiratory failure and died more often in the ICU (65% vs. 38%, p = 0.047). Forty-seven % of patients were defined as Carbon Dioxide Responders. These patients were older and had more comorbidities; however, no difference in terms of ICU mortality was observed (51% vs. 37%, p = 0.189 for Carbon Dioxide Responders and Non-Responders, respectively). CONCLUSIONS: During the COVID-19 pandemic, prone position has been widely adopted to treat mechanically ventilated patients with respiratory failure. The majority of patients improved their oxygenation during prone position, most likely due to a better ventilation perfusion matching. TRIAL REGISTRATION: clinicaltrials.gov number: NCT04388670.


Subject(s)
COVID-19/therapy , Critical Care/standards , Intubation/standards , Patient Positioning/standards , Prone Position , Respiration, Artificial/standards , Supine Position , Aged , Cohort Studies , Female , Humans , Italy , Male , Middle Aged , Practice Guidelines as Topic , Retrospective Studies
4.
Crit Care ; 25(1): 74, 2021 02 19.
Article in English | MEDLINE | ID: covidwho-1090628

ABSTRACT

BACKGROUND: Biomarkers can be used to detect the presence of endothelial and/or alveolar epithelial injuries in case of ARDS. Angiopoietin-2 (Ang-2), soluble intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion protein-1 (VCAM-1), P-selectin and E-selectin are biomarkers of endothelial injury, whereas the receptor for advanced glycation end-products (RAGE) reflects alveolar epithelial injury. The aims of this study were to evaluate whether the plasma concentration of the above-mentioned biomarkers was different 1) in survivors and non-survivors of COVID-19-related ARDS and 2) in COVID-19-related and classical ARDS. METHODS: This prospective study was performed in two COVID-19-dedicated Intensive Care Units (ICU) and one non-COVID-19 ICU at Ferrara University Hospital. A cohort of 31 mechanically ventilated patients with COVID-19 ARDS and a cohort of 11 patients with classical ARDS were enrolled. Ang-2, ICAM-1, VCAM-1, P-selectin, E-selectin and RAGE were determined with a bead-based multiplex immunoassay at three time points: inclusion in the study (T1), after 7 ± 2 days (T2) and 14 ± 2 days (T3). The primary outcome was to evaluate the plasma trend of the biomarker levels in survivors and non-survivors. The secondary outcome was to evaluate the differences in respiratory mechanics variables and gas exchanges between survivors and non-survivors. Furthermore, we compared the plasma levels of the biomarkers at T1 in patients with COVID-19-related ARDS and classical ARDS. RESULTS: In COVID-19-related ARDS, the plasma levels of Ang-2 and ICAM-1 at T1 were statistically higher in non-survivors than survivors, (p = 0.04 and p = 0.03, respectively), whereas those of P-selectin, E-selectin and RAGE did not differ. Ang-2 and ICAM-1 at T1 were predictors of mortality (AUROC 0.650 and 0.717, respectively). At T1, RAGE and P-selectin levels were higher in classical ARDS than in COVID-19-related ARDS. Ang-2, ICAM-1 and E-selectin were lower in classical ARDS than in COVID-19-related ARDS (all p < 0.001). CONCLUSIONS: COVID-19 ARDS is characterized by an early pulmonary endothelial injury, as detected by Ang-2 and ICAM-1. COVID-19 ARDS and classical ARDS exhibited a different expression of biomarkers, suggesting different pathological pathways. Trial registration NCT04343053 , Date of registration: April 13, 2020.


Subject(s)
Biomarkers/analysis , Lung Injury/diagnosis , Respiration, Artificial/adverse effects , Aged , Antigens, Neoplasm/analysis , Antigens, Neoplasm/blood , Area Under Curve , COVID-19/blood , COVID-19/prevention & control , Cohort Studies , E-Selectin/analysis , E-Selectin/blood , Female , Humans , Intensive Care Units/organization & administration , Intensive Care Units/statistics & numerical data , Intercellular Adhesion Molecule-1/analysis , Intercellular Adhesion Molecule-1/blood , Lung Injury/blood , Lung Injury/physiopathology , Male , Middle Aged , Mitogen-Activated Protein Kinases/analysis , Mitogen-Activated Protein Kinases/blood , P-Selectin/analysis , P-Selectin/blood , Prospective Studies , ROC Curve , Respiration, Artificial/standards , Respiration, Artificial/statistics & numerical data , Respiratory Distress Syndrome/blood , Respiratory Distress Syndrome/physiopathology , Versicans/analysis , Versicans/blood , Vesicular Transport Proteins/analysis , Vesicular Transport Proteins/blood
7.
Best Pract Res Clin Anaesthesiol ; 35(3): 351-368, 2021 Oct.
Article in English | MEDLINE | ID: covidwho-1049749

ABSTRACT

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) induces coronavirus-19 disease (COVID-19) and is a major health concern. Following two SARS-CoV-2 pandemic "waves," intensive care unit (ICU) specialists are treating a large number of COVID19-associated acute respiratory distress syndrome (ARDS) patients. From a pathophysiological perspective, prominent mechanisms of COVID19-associated ARDS (CARDS) include severe pulmonary infiltration/edema and inflammation leading to impaired alveolar homeostasis, alteration of pulmonary physiology resulting in pulmonary fibrosis, endothelial inflammation (endotheliitis), vascular thrombosis, and immune cell activation. Although the syndrome ARDS serves as an umbrella term, distinct, i.e., CARDS-specific pathomechanisms and comorbidities can be noted (e.g., virus-induced endotheliitis associated with thromboembolism) and some aspects of CARDS can be considered ARDS "atypical." Importantly, specific evidence-based medical interventions for CARDS (with the potential exception of corticosteroid use) are currently unavailable, limiting treatment efforts to mostly supportive ICU care. In this article, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS. In addition, we will outline current and potential future treatment approaches.


Subject(s)
COVID-19/therapy , Critical Care/standards , Health Knowledge, Attitudes, Practice , Intensive Care Units/standards , Respiratory Distress Syndrome/therapy , Adrenal Cortex Hormones/administration & dosage , Anticoagulants/administration & dosage , COVID-19/diagnosis , COVID-19/physiopathology , Critical Care/trends , Humans , Immunologic Factors/administration & dosage , Intensive Care Units/trends , Respiration, Artificial/standards , Respiration, Artificial/trends , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology
8.
AANA J ; 89(1): 62-69, 2021 Feb.
Article in English | MEDLINE | ID: covidwho-1049415

ABSTRACT

The coronavirus disease 2019 (COVID-19) respiratory illness has increased the amount of people needing airway rescue and the support of mechanical ventilators. In doing so, the pandemic has increased the demand of healthcare professionals to manage these critically ill individuals. Certified Registered Nurse Anesthetists (CRNAs), who are trained experts in airway management and mechanical ventilation with experience in intensive care units (ICUs), rise to this challenge. However, many CRNAs may be unfamiliar with advancements in critical care ventilators. The purpose of this review is to provide a resource for CRNAs returning to the ICU to manage patients requiring invasive mechanical ventilation. The most common ventilator modes found in anesthesia machine ventilators and ICU ventilators are reviewed, as are the lung-protective ventilation strategies, including positive end-expiratory pressure, used to manage patients with COVID-19-induced acute respiratory distress syndrome. Adjuncts to mechanical ventilation, recruitment maneuvers, prone positioning, and extracorporeal membrane oxygenation are also reviewed. More research is needed concerning the management of COVID-19-infected patients, and CRNAs must become familiar with their ICU units' individual ventilator machine, but this brief review provides a good place to start for those returning to the ICU.


Subject(s)
Anesthesia/statistics & numerical data , Anesthesia/standards , COVID-19/therapy , Critical Care/standards , Respiration, Artificial/standards , Respiratory Distress Syndrome/therapy , Ventilators, Mechanical/standards , Critical Care/statistics & numerical data , Humans , Intensive Care Units/statistics & numerical data , Pandemics , Practice Guidelines as Topic , Respiration, Artificial/statistics & numerical data , SARS-CoV-2 , Ventilators, Mechanical/statistics & numerical data
9.
Adv Respir Med ; 89(1): 1-7, 2021.
Article in English | MEDLINE | ID: covidwho-1038735

ABSTRACT

INTRODUCTION: One important concern during the management of COVID-19 pneumonia patients with acute hypoxemic respiratory failure is early anticipation of the need for intubation. ROX is an index that can help in identification of patients with low and those with high risk of intubation. So, this study was planned to validate the diagnostic accuracy of the ROX index for prediction of COVID-19 pneumonia outcome (the need for intubation) and, in addition, to underline the significant association of the ROX index with clinical, radiological, demographic data. MATERIAL AND METHODS: Sixty-nine RT-PCR positive COVID-19 patients were enrolled. The following data were collected: medical history, clinical classification of COVID-19 infection, the ROX index measured daily and the outcome assessment. RESULTS: All patients with severe COVID-19 infection (100%) were intubated (50% of them on the 3rd day of admission), but only 38% of patients with moderate COVID-19 infection required intubation (all of them on the 3rd day of admission). The ROX index on the 1st day of admission was significantly associated with the presence of comorbidities, COVID-19 clinical classification, CT findings and intubation (p ≤ 0.001 for each of them). Regression analysis showed that sex and ROX.1 are the only significant independent predictors of intubation [AOR (95% CI): 16.9 (2.4- 117), 0.77 (0.69-0.86)], respectively. Cut-off point of the ROX index on the 1st day of admission was ≤ 25.26 (90.2% of sensitivity and 75% of specificity). CONCLUSIONS: ROX is a simple noninvasive promising tool for predicting discontinuation of high-flow oxygen therapy and could be used in the assessment of progress and the risk of intubation in COVID-19 patients with pneumonia.


Subject(s)
COVID-19/therapy , Oxygen Inhalation Therapy/standards , Respiration, Artificial/standards , Adult , Blood Gas Analysis , COVID-19/epidemiology , Female , Humans , Male , Middle Aged , Respiratory Rate , Severity of Illness Index
10.
Acta Otorrinolaringol Esp (Engl Ed) ; 71(6): 386-392, 2020.
Article in Spanish | MEDLINE | ID: covidwho-1002943

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
11.
Med Intensiva (Engl Ed) ; 44(8): 493-499, 2020 Nov.
Article in Spanish | MEDLINE | ID: covidwho-1002891

ABSTRACT

The current COVID-19 pandemic has rendered up to 15% of patients under mechanical ventilation. Because the subsequent tracheotomy is a frequent procedure, the three societies mostly involved (SEMICYUC, SEDAR and SEORL-CCC) have setup a consensus paper that offers an overview about indications and contraindications of tracheotomy, be it by puncture or open, clarifying its respective advantages and enumerating the ideal conditions under which they should be performed, as well as the necessary steps. Regular and emergency situations are displayed together with the postoperative measures.


Subject(s)
Betacoronavirus , Consensus , Coronavirus Infections/epidemiology , Pneumonia, Viral/epidemiology , Societies, Medical , Tracheostomy/standards , Anesthesiology , Bronchoscopy/adverse effects , Bronchoscopy/standards , COVID-19 , Contraindications, Procedure , Coronary Care Units , Elective Surgical Procedures/standards , Emergencies , Humans , Intensive Care Units , Otolaryngology , Otorhinolaryngologic Surgical Procedures , Pandemics , Postoperative Care/methods , Postoperative Care/standards , Respiration, Artificial/standards , Resuscitation , SARS-CoV-2 , Spain/epidemiology , Time Factors , Tracheostomy/adverse effects , Tracheostomy/methods
12.
Respir Physiol Neurobiol ; 285: 103611, 2021 03.
Article in English | MEDLINE | ID: covidwho-989142

ABSTRACT

Exacerbation of COVID-19 pandemic may lead to acute shortage of ventilators, which may require shared use of ventilator as a lifesaving concept. Two model lungs were ventilated with one ventilator to i) test the adequacy of individual tidal volumes via capnography, ii) assess cross-breathing between lungs, and iii) offer a simulation-based algorithm for ensuring equal tidal volumes. Ventilation asymmetry was induced by placing rubber band around one model lung, and the uneven distribution of tidal volumes (VT) was counterbalanced by elevating airflow resistance (HR) contralaterally. VT, end-tidal CO2 concentration (ETCO2), and peak inspiratory pressure (Ppi) were measured. Unilateral LC reduced VT and elevated ETCO2 on the affected side. Under HR, VT and ETCO2 were re-equilibrated. In conclusion, capnography serves as simple, bedside method for controlling the adequacy of split ventilation in each patient. No collateral gas flow was observed between the two lungs with different time constants. Ventilator sharing may play a role in emergency situations.


Subject(s)
COVID-19/therapy , Capnography/standards , Lung/physiopathology , Models, Biological , Respiration, Artificial/instrumentation , Respiration, Artificial/standards , COVID-19/diagnosis , Computer Simulation , Emergency Medical Services , Humans , Models, Anatomic , Point-of-Care Testing/standards , Respiratory Function Tests
13.
Am J Med Sci ; 362(1): 13-23, 2021 07.
Article in English | MEDLINE | ID: covidwho-985079

ABSTRACT

Acute respiratory distress syndrome (ARDS) is a clinically and biologically heterogeneous disorder associated with a variety of disease processes that lead to acute lung injury with increased non-hydrostatic extravascular lung water, reduced compliance, and severe hypoxemia. Despite significant advances, mortality associated with this syndrome remains high. Mechanical ventilation remains the most important aspect of managing patients with ARDS. An in-depth knowledge of lung protective ventilation, optimal PEEP strategies, modes of ventilation and recruitment maneuvers are essential for ventilatory management of ARDS. Although, the management of ARDS is constantly evolving as new studies are published and guidelines being updated; we present a detailed review of the literature including the most up-to-date studies and guidelines in the management of ARDS. We believe this review is particularly helpful in the current times where more than half of the acute care hospitals lack in-house intensivists and the burden of ARDS is at large.


Subject(s)
Disease Management , Extracorporeal Membrane Oxygenation/standards , Practice Guidelines as Topic/standards , Respiration, Artificial/standards , Respiratory Distress Syndrome/therapy , Extracorporeal Membrane Oxygenation/methods , Humans , Positive-Pressure Respiration/methods , Positive-Pressure Respiration/standards , Respiration, Artificial/methods , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/physiopathology
14.
Anesthesiology ; 132(6): 1317-1332, 2020 06.
Article in English | MEDLINE | ID: covidwho-944425

ABSTRACT

The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the critically ill patients with COVID-19 in Wuhan. It is extremely important to follow strict self-protection precautions. Timely, but not premature, intubation is crucial to counter a progressively enlarging oxygen debt despite high-flow oxygen therapy and bilevel positive airway pressure ventilation. Thorough preparation, satisfactory preoxygenation, modified rapid sequence induction, and rapid intubation using a video laryngoscope are widely used intubation strategies in Wuhan. Lung-protective ventilation, prone position ventilation, and adequate sedation and analgesia are essential components of ventilation management.


Subject(s)
Coronavirus Infections , Disease Transmission, Infectious/prevention & control , Intubation, Intratracheal/standards , Pandemics , Pneumonia, Viral , Respiration, Artificial/standards , COVID-19 , China , Coronavirus Infections/epidemiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Hospitals/standards , Humans , Pandemics/prevention & control , Patient Selection , Pneumonia, Viral/epidemiology , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission
15.
Afr J Reprod Health ; 24(s1): 117-124, 2020 Jun.
Article in English | MEDLINE | ID: covidwho-903322

ABSTRACT

COVID-19 is a new lethal disease with limited information on its transmissibility, the severity of its sequelae, its clinical manifestations, and epidemiology. This commentary analyzed the global epidemiology of COVID-19 among the vulnerable population. The analysis revealed that most pediatric COVID-19 cases are not severe, but related severe illness still occurs in children. All ages of children are susceptible to COVID-19, and no significant gender difference exists. COVID-19 infection during pregnancy produced fatal outcomes for mothers, but less risky for the baby. The hot spot clusters for COVID-19 are the prisons/jails, nursing/group homes, and long-term facilities where most of the vulnerable populations reside. Ethnic minority groups in the USA and UK are disproportionately exposed to COVID-19 infection and death than Caucasians. The difference may be because ethnic minorities are exposed to higher risks at work and the long-standing structural economic and health disparities in the two countries. There are now changes in guidelines on who is qualified to receive ventilators in dire situations in many countries around the world if the healthcare system is overwhelmed.


Subject(s)
COVID-19/epidemiology , Adolescent , Adult , Age Factors , Aged , Aged, 80 and over , COVID-19/ethnology , COVID-19/mortality , Child , Child, Preschool , Comoros , Disabled Persons/statistics & numerical data , Female , Health Care Rationing/standards , Healthcare Disparities/ethnology , Humans , Infant , Infant, Newborn , Male , Middle Aged , Practice Guidelines as Topic , Pregnancy , Pregnancy Complications, Infectious/epidemiology , Pregnancy Complications, Infectious/pathology , Residential Facilities/statistics & numerical data , Respiration, Artificial/standards , Risk Factors , SARS-CoV-2 , Severity of Illness Index , Sex Factors , Vulnerable Populations/statistics & numerical data , Young Adult
17.
J Hosp Infect ; 106(3): 570-576, 2020 Nov.
Article in English | MEDLINE | ID: covidwho-723894

ABSTRACT

BACKGROUND: Identifying the extent of environmental contamination of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is essential for infection control and prevention. The extent of environmental contamination has not been fully investigated in the context of severe coronavirus disease (COVID-19) patients. AIM: To investigate environmental SARS-CoV-2 contamination in the isolation rooms of severe COVID-19 patients requiring mechanical ventilation or high-flow oxygen therapy. METHODS: Environmental swab samples and air samples were collected from the isolation rooms of three COVID-19 patients with severe pneumonia. Patients 1 and 2 received mechanical ventilation with a closed suction system, while patient 3 received high-flow oxygen therapy and non-invasive ventilation. Real-time reverse transcription-polymerase chain reaction (rRT-PCR) was used to detect SARS-CoV-2; viral cultures were performed for samples not negative on rRT-PCR. FINDINGS: Of the 48 swab samples collected in the rooms of patients 1 and 2, only samples from the outside surfaces of the endotracheal tubes tested positive for SARS-CoV-2 by rRT-PCR. However, in patient 3's room, 13 of the 28 environmental samples (fomites, fixed structures, and ventilation exit on the ceiling) showed positive results. Air samples were negative for SARS-CoV-2. Viable viruses were identified on the surface of the endotracheal tube of patient 1 and seven sites in patient 3's room. CONCLUSION: Environmental contamination of SARS-CoV-2 may be a route of viral transmission. However, it might be minimized when patients receive mechanical ventilation with a closed suction system. These findings can provide evidence for guidelines for the safe use of personal protective equipment.


Subject(s)
Coronavirus Infections/therapy , Decontamination/standards , Environmental Pollution/analysis , Hyperbaric Oxygenation/standards , Patients' Rooms/standards , Pneumonia, Viral/therapy , Pneumonia/therapy , Practice Guidelines as Topic , Respiration, Artificial/standards , Air Microbiology , COVID-19 , Humans , Pandemics
18.
Medwave ; 20(6): e7950, 2020 Jul 02.
Article in Spanish, English | MEDLINE | ID: covidwho-696250

ABSTRACT

The purpose of this article is to review the characteristics of SARS-CoV-2, the clinical-epidemiological aspects of COVID-19, and the implications anesthesiologists when performing aerosol-generating procedures. A search of PubMed/MEDLINE, Scopus, SciELO, and Web of Science databases was performed until April 9, 2020, using the words: "COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia". Forty-eight articles with information on the management of the patient in the perioperative period or the intensive care unit when suspected or confirmed SARS-CoV-2 infection were included. In general, the postponement of elective surgeries for no more than 6 to 8 weeks, depending on the clinical condition of the patients is recommended. In the case of urgent or emergency surgeries, we review the use of personal protection gear, as well as the recommended strategies for carrying out the procedure.


El objetivo de este artículo es revisar las características del SARS-CoV-2, los aspectos clínico-epidemiológicos de COVID-19 y las implicaciones que tienen para los anestesiólogos al realizar procedimientos generadores de aerosoles. Se realizó una búsqueda en las bases de datos PubMed, Scopus, SciELO y Web of Science hasta el 9 de abril de 2020, utilizando las palabras: “COVID-19 or COVID19 or SARS-CoV-2 and anesthesiology or anesthesia”. Se incluyeron 48 artículos con información sobre el manejo del paciente en el perioperatorio o en la unidad de cuidados intensivos ante la sospecha o confirmación de infección por SARS-CoV-2. En general, se recomienda el aplazamiento de las cirugías electivas por no más de seis a ocho semanas, de acuerdo a las condiciones clínicas de los pacientes. En el caso de cirugías de urgencia o emergencia, se revisan tópicos del sistema de protección personal así como las estrategias recomendadas para la realización de los procedimientos.


Subject(s)
Anesthesiology/standards , Betacoronavirus , Coronavirus Infections/complications , Coronavirus Infections/epidemiology , Occupational Diseases/prevention & control , Pneumonia, Viral/complications , Pneumonia, Viral/epidemiology , Aerosols , Anesthesia, Conduction/methods , Anesthesia, Epidural/methods , Anesthesia, General/methods , Anesthesia, Spinal/methods , Anesthesiology/organization & administration , Betacoronavirus/genetics , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/transmission , Elective Surgical Procedures , Humans , Intensive Care Units , Intubation, Intratracheal/methods , Intubation, Intratracheal/standards , Nerve Block/methods , Pandemics , Personal Protective Equipment , Pneumonia, Viral/diagnosis , Pneumonia, Viral/transmission , Respiration, Artificial/methods , Respiration, Artificial/standards , SARS-CoV-2 , Surgical Procedures, Operative , Symptom Assessment/methods
19.
Crit Care Med ; 48(6): e440-e469, 2020 06.
Article in English | MEDLINE | ID: covidwho-685042

ABSTRACT

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations. RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. No recommendation was provided for six questions. The topics were: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy. CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines.


Subject(s)
Coronavirus Infections/therapy , Intensive Care Units/organization & administration , Pneumonia, Viral/therapy , Practice Guidelines as Topic/standards , Betacoronavirus , COVID-19 , Critical Illness , Diagnostic Techniques and Procedures/standards , Humans , Infection Control/methods , Infection Control/standards , Intensive Care Units/standards , Pandemics , Respiration, Artificial/methods , Respiration, Artificial/standards , SARS-CoV-2 , Shock/therapy
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