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Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).
Crit Care Med. 2020 06; 48(6):e440-e469.CC

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.

Authors+Show Affiliations

Department of Medicine, McMaster University, Hamilton, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.Copenhagen University Hospital Rigshospitalet, Department of Intensive Care, Copenhagen, Denmark. Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Intensive Care Department, Ministry of National Guard Health Affairs, King Saud Bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia.Department of Medicine, McMaster University, Hamilton, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Montefiore Healthcare System/Albert Einstein College of Medicine, Bronx, New York, USA.Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.Department of Medicine, McMaster University, Hamilton, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada.Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA. Rhode Island Hospital, Providence, Rhode Island, USA.Department of Intensive Care Medicine, University medical Center Utrecht, Utrecht University, the Netherlands. Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.Department of Pharmacy, New York-Presbyterian Hospital, Columbia University Irving Medical Center, New York, New York, USA.Medical ICU, Peking Union Medical College Hospital, Beijing.Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Montefiore Healthcare System/Albert Einstein College of Medicine, Bronx, New York, USA.Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada. Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada.Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy.Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Critical Care Medicine Department, National Institutes of Health Clinical Center and Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, USA.Faculty of Medicine, Imperial College, London, UK.Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.Department of Medicine, McMaster University, Hamilton, Canada. Population Health Research Institute, Hamilton, Canada.Department of Anesthesia and Intensive Care, Humanitas Clinical and Research Center, Rozzano, Milan, Italy. Department of Biomedical Science, Humanitas University, Pieve Emanuele, Milan, Italy.Microbiology and Infection control, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK.Emory University Hospital, Atlanta, Georgia, USA.Department of Intensive Care Medicine, University medical Center Utrecht, Utrecht University, the Netherlands.Division of Infectious Diseases, University of Toronto, Toronto, Canada.Warren Alpert School of Medicine at Brown University, Providence, Rhode Island, USA.Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA.Department of Health Research Methods, Evidence, and Impact, McMaster University, Canada. GUIDE Research Methods Group, Hamilton, Canada (https://guidecanada.org).Houston Children's Hospital, Baylor College of Medicine, Houston, Texas, USA.Department of Anesthesia, McMaster University, Hamilton, Canada.Department of Medicine and Surgery, Milano-Bicocca University, Milano, Italy. ASST-Monza, Desio and San Gerardo Hospital, Monza, Italy.Department of Medicine, McMaster University, Hamilton, Canada. Department of Emergency Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia.Director, Research & Innovation Centre, King Saud Medical City, Ministry of Health, Riyadh, Kingdom of Saudi Arabia.Critical Care Division, The George Institute for Global Health and UNSW Sydney, Australia. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, Australia.Division of Infectious Diseases and International Health, Department of Medicine, University of, Virginia, School of Medicine, Charlottesville, Virginia, USA.Division of Pulmonary, Critical Care, and Sleep Medicine, University of Washington, USA.Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32224769

Citation

Alhazzani, Waleed, et al. "Surviving Sepsis Campaign: Guidelines On the Management of Critically Ill Adults With Coronavirus Disease 2019 (COVID-19)." Critical Care Medicine, vol. 48, no. 6, 2020, pp. e440-e469.
Alhazzani W, Møller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020;48(6):e440-e469.
Alhazzani, W., Møller, M. H., Arabi, Y. M., Loeb, M., Gong, M. N., Fan, E., Oczkowski, S., Levy, M. M., Derde, L., Dzierba, A., Du, B., Aboodi, M., Wunsch, H., Cecconi, M., Koh, Y., Chertow, D. S., Maitland, K., Alshamsi, F., Belley-Cote, E., ... Rhodes, A. (2020). Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Critical Care Medicine, 48(6), e440-e469. https://doi.org/10.1097/CCM.0000000000004363
Alhazzani W, et al. Surviving Sepsis Campaign: Guidelines On the Management of Critically Ill Adults With Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020;48(6):e440-e469. PubMed PMID: 32224769.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). AU - Alhazzani,Waleed, AU - Møller,Morten Hylander, AU - Arabi,Yaseen M, AU - Loeb,Mark, AU - Gong,Michelle Ng, AU - Fan,Eddy, AU - Oczkowski,Simon, AU - Levy,Mitchell M, AU - Derde,Lennie, AU - Dzierba,Amy, AU - Du,Bin, AU - Aboodi,Michael, AU - Wunsch,Hannah, AU - Cecconi,Maurizio, AU - Koh,Younsuck, AU - Chertow,Daniel S, AU - Maitland,Kathryn, AU - Alshamsi,Fayez, AU - Belley-Cote,Emilie, AU - Greco,Massimiliano, AU - Laundy,Matthew, AU - Morgan,Jill S, AU - Kesecioglu,Jozef, AU - McGeer,Allison, AU - Mermel,Leonard, AU - Mammen,Manoj J, AU - Alexander,Paul E, AU - Arrington,Amy, AU - Centofanti,John E, AU - Citerio,Giuseppe, AU - Baw,Bandar, AU - Memish,Ziad A, AU - Hammond,Naomi, AU - Hayden,Frederick G, AU - Evans,Laura, AU - Rhodes,Andrew, PY - 2020/4/1/pubmed PY - 2020/6/5/medline PY - 2020/4/1/entrez SP - e440 EP - e469 JF - Critical care medicine JO - Crit Care Med VL - 48 IS - 6 N2 - 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. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/32224769/Surviving_Sepsis_Campaign:_Guidelines_on_the_Management_of_Critically_Ill_Adults_with_Coronavirus_Disease_2019__COVID_19__ DB - PRIME DP - Unbound Medicine ER -