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Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.
Nasa, Prashant; Azoulay, Elie; Khanna, Ashish K; Jain, Ravi; Gupta, Sachin; Javeri, Yash; Juneja, Deven; Rangappa, Pradeep; Sundararajan, Krishnaswamy; Alhazzani, Waleed; Antonelli, Massimo; Arabi, Yaseen M; Bakker, Jan; Brochard, Laurent J; Deane, Adam M; Du, Bin; Einav, Sharon; Esteban, Andrés; Gajic, Ognjen; Galvagno, Samuel M; Guérin, Claude; Jaber, Samir; Khilnani, Gopi C; Koh, Younsuck; Lascarrou, Jean-Baptiste; Machado, Flavia R; Malbrain, Manu L N G; Mancebo, Jordi; McCurdy, Michael T; McGrath, Brendan A; Mehta, Sangeeta; Mekontso-Dessap, Armand; Mer, Mervyn; Nurok, Michael; Park, Pauline K; Pelosi, Paolo; Peter, John V; Phua, Jason; Pilcher, David V; Piquilloud, Lise; Schellongowski, Peter; Schultz, Marcus J; Shankar-Hari, Manu; Singh, Suveer; Sorbello, Massimiliano; Tiruvoipati, Ravindranath; Udy, Andrew A; Welte, Tobias; Myatra, Sheila N.
  • Nasa P; Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates.
  • Azoulay E; Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France.
  • Khanna AK; Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA.
  • Jain R; Mahatma Gandhi Medical College and Hospital, Jaipur, India.
  • Gupta S; Narayana Super Speciality Hospital, Gurugram, India.
  • Javeri Y; Regency Super Speciality Hospital, Lucknow, India.
  • Juneja D; Max Super Speciality Hospital, New Delhi, India.
  • Rangappa P; Columbia Asia Referral Hospital, Bengaluru, India.
  • Sundararajan K; Royal Adelaide Hospital and The University of Adelaide, Adelaide, Australia.
  • Alhazzani W; McMaster University, Hamilton, Canada.
  • Antonelli M; Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
  • Arabi YM; King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia.
  • Bakker J; New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA.
  • Brochard LJ; Erasmus MC University Medical Center, Rotterdam, The Netherlands.
  • Deane AM; Pontificia Universidad Catolica de Chile, Santiago, Chile.
  • Du B; Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada.
  • Einav S; Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia.
  • Esteban A; Peking Union Medical College Hospital, Peking, China.
  • Gajic O; The Shaare Zedek Medical Center, Jerusalem, Israel.
  • Galvagno SM; Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain.
  • Guérin C; Mayo Clinic, Maryland, USA.
  • Jaber S; University of Maryland, Maryland, USA.
  • Khilnani GC; University de Lyon, Lyon, France.
  • Koh Y; Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France.
  • Lascarrou JB; Montpellier University Hospital, Montpellier, France.
  • Machado FR; Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France.
  • Malbrain MLNG; PSRI Hospital, New Delhi, India.
  • Mancebo J; Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
  • McCurdy MT; Nantes University Hospital, Nantes, France.
  • McGrath BA; Federal University of São Paulo, São Paulo, Brazil.
  • Mehta S; International Fluid Academy, Lovenjoel, Belgium.
  • Mekontso-Dessap A; Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
  • Mer M; Hospital Universitari Sant Pau, Barcelona, Spain.
  • Nurok M; University of Maryland School of Medicine, Maryland, USA.
  • Park PK; Manchester University NHS Foundation Trust, Manchester, UK.
  • Pelosi P; Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK.
  • Peter JV; Sinai Health and the University of Toronto, Toronto, Canada.
  • Phua J; Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France.
  • Pilcher DV; Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
  • Piquilloud L; Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA.
  • Schellongowski P; University of Michigan, Ann Arbor, USA.
  • Schultz MJ; San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy.
  • Shankar-Hari M; Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy.
  • Singh S; Christian Medical College, Vellore, India.
  • Sorbello M; Alexandra Hospital and National University Hospital, Singapore, Singapore.
  • Tiruvoipati R; Alfred Health, and Monash University, Melbourne, Australia.
  • Udy AA; Lausanne University Hospital and Lausanne University, Lausanne, Switzerland.
  • Welte T; Medical University of Vienna, Vienna, Austria.
  • Myatra SN; Amsterdam University Medical Center, Amsterdam, The Netherlands.
Crit Care ; 25(1): 106, 2021 03 16.
Article in English | MEDLINE | ID: covidwho-1136238
Semantic information from SemMedBD (by NLM)
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oxygen
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2. Noninvasive Ventilation TREATS Hypercapnic respiratory failure
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Hypercapnic respiratory failure
3. Adrenal Cortex Hormones TREATS COVID-19
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Adrenal Cortex Hormones
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TREATS
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COVID-19
4. Adrenal Cortex Hormones AFFECTS Alveolar ventilation function
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Alveolar ventilation function
5. Noninvasive Ventilation TREATS Patients
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TREATS
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6. Hypercapnic respiratory failure PROCESS_OF Patients
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Hypercapnic respiratory failure
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PROCESS_OF
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7. Respiration AFFECTS Alveolar ventilation function
Subject
Respiration
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AFFECTS
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Alveolar ventilation function
8. Neuromuscular Blocking Agents TREATS Patient ventilator dyssynchrony
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TREATS
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Patient ventilator dyssynchrony
9. respiratory management TREATS Patients
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respiratory management
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10. oxygen PART_OF Nose
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oxygen
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Nose
11. Noninvasive Ventilation TREATS Hypercapnic respiratory failure
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TREATS
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Hypercapnic respiratory failure
12. Adrenal Cortex Hormones TREATS COVID-19
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Adrenal Cortex Hormones
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TREATS
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COVID-19
13. Adrenal Cortex Hormones AFFECTS Alveolar ventilation function
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Alveolar ventilation function
14. Noninvasive Ventilation TREATS Patients
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Noninvasive Ventilation
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15. Hypercapnic respiratory failure PROCESS_OF Patients
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Hypercapnic respiratory failure
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Patients
16. Respiration AFFECTS Alveolar ventilation function
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Respiration
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Alveolar ventilation function
17. Neuromuscular Blocking Agents TREATS Patient ventilator dyssynchrony
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Neuromuscular Blocking Agents
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TREATS
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Patient ventilator dyssynchrony
18. respiratory management TREATS Patients
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respiratory management
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TREATS
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ABSTRACT

BACKGROUND:

Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice.

METHODS:

Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (χ2) test (p < 0·05 was considered as unstable).

RESULTS:

Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment.

CONCLUSION:

Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. TRIAL REGISTRATION The study was registered with Clinical trials.gov Identifier NCT04534569.
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Keywords

Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Delphi Technique / Consensus / COVID-19 Type of study: Clinical Practice Guide / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03491-y

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Insufficiency / Delphi Technique / Consensus / COVID-19 Type of study: Clinical Practice Guide / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Crit Care Year: 2021 Document Type: Article Affiliation country: S13054-021-03491-y