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Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update.
Crit Care Med. 2021 03 01; 49(3):e219-e234.CC

Abstract

BACKGROUND

The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.

METHODS

The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

RESULTS

The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning.

CONCLUSION

The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.

Authors+Show Affiliations

Department of Medicine, McMaster University, Hamilton, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.Department of Pulmonary and Critical Care Medicine, University of Washington, Seattle, WA.Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.Copenhagen University Hospital Rigshospitalet, Department of Intensive Care, Copenhagen, Denmark. Scandinavian Society of Anaesthesiology and Intensive Care Medicine (SSAI).Department of Critical Care, King's College London, Guy's & St Thomas' Hospital, London, United Kingdom.Department of Medicine, University of Michigan, Ann Arbor and VA Ann Arbor Healthcare System, Ann Arbor, MI.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, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.Division of Critical Care Medicine, Division of Pulmonary Medicine, Department of Medicine, Montefiore Healthcare System/Albert Einstein College of Medicine, The Bronx, NY.Interdepartmental Division of Critical Care Medicine and the Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.Department of Medicine, McMaster University, Hamilton, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.Warren Alpert School of Medicine at Brown University, Providence, RI. Rhode Island Hospital, Providence, RI.Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. Julius Center for Health Sciences and Primary Care, Utrecht, The Netherlands.Department of Pharmacy, NewYork-Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY.State Key Laboratory of Complex, Severe, and Rare Diseases, Medical ICU, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.Anaesthesiology, Pain and Intensive Care Department, Universidade Federal de Sao Paulo, Sao Paulo, Brazil.Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada. Department of Anesthesia and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.Department of Medicine, McMaster University, Hamilton, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy. Humanitas University, Department of Biomedical Sciences, Milan, Italy.Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada.Critical Care Medicine Department, National Institutes of Health Clinical Center and Laboratory of Immunoregulation, National Institute of Allergy and Infectious Diseases, Bethesda, MD.Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.Department of Medicine, McMaster University, Hamilton, ON, Canada. Population Health Research Institute, Hamilton, ON, Canada.Humanitas Clinical and Research Center-IRCCS, Rozzano (Mi), Italy. Humanitas University, Department of Biomedical Sciences, Milan, Italy.Chair of Epidemiology and Preventive Medicine, Department of Hygiene and Dietetics, Jagiellonian University Medical College, Kraków, Poland.Department of Internal Medicine, University of Manitoba, Winnipeg, MB, Canada.Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.Division of Infectious Diseases, University of Toronto, Toronto, ON, Canada.Warren Alpert School of Medicine at Brown University, Providence, RI.Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, NY.Department of Anaesthesiology, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India.Houston Children's Hospital, Baylor College of Medicine, Houston, TX.Vanderbilt University School of Nursing, Nashville, TN and Rush University College of Nursing, Chicago, IL.School of Medicine and Surgery, Milano-Bicocca University, Milano, Italy. ASST-Monza, San Gerardo Hospital, Monza, Italy.Department of Medicine, McMaster University, Hamilton, ON, Canada. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada.Biobehavioral Nursing and Health Informatics-University of Washington School of Nursing/University of Washington Medical Center, Seattle, WA.Director, Research & Innovation Centre, King Saud Medical City, Ministry of Health & College of Medicine, Alfaisal University, Riyadh, Kingdom of Saudi Arabia.Critical Care Division, The George Institute for Global Health and UNSW, Sydney, NSW, Australia. Malcolm Fisher Department of Intensive Care, Royal North Shore Hospital, Sydney, NSW, Australia.Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, School of Medicine, Charlottesville, VA.Department of Emergency and Critical Care, Imam Abdulrahman Ben Faisal University, Dammam, Saudi Arabia.Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. Department of Critical Care Medicine, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, Department of Medicine, Emory University School of Medicine and Grady Memorial Hospital, Atlanta, GA.Perelman School of Medicine, University of Pennsylvania; Department of Surgery; Division of Traumatology, Surgical Critical Care and Emergency Surgery, Philadelphia, PA.Department of Surgery and Emory Critical Care center, Emory University School of Medicine, Atlanta, GA.Department of Anesthesiology Intensive Care and Emergency Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. Istituto di Anestesiologia e Rianimazione, Università Cattolica del Sacro Cuore, Rome, Italy.Adult Critical Care, St George's University Hospitals NHS Foundation Trust & St George's University of London, London, United Kingdom.

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

33555780

Citation

Alhazzani, Waleed, et al. "Surviving Sepsis Campaign Guidelines On the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update." Critical Care Medicine, vol. 49, no. 3, 2021, pp. e219-e234.
Alhazzani W, Evans L, Alshamsi F, et al. Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update. Crit Care Med. 2021;49(3):e219-e234.
Alhazzani, W., Evans, L., Alshamsi, F., Møller, M. H., Ostermann, M., Prescott, H. C., Arabi, Y. M., Loeb, M., Ng Gong, M., Fan, E., Oczkowski, S., Levy, M. M., Derde, L., Dzierba, A., Du, B., Machado, F., Wunsch, H., Crowther, M., Cecconi, M., ... Rhodes, A. (2021). Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update. Critical Care Medicine, 49(3), e219-e234. https://doi.org/10.1097/CCM.0000000000004899
Alhazzani W, et al. Surviving Sepsis Campaign Guidelines On the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update. Crit Care Med. 2021 03 1;49(3):e219-e234. PubMed PMID: 33555780.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update. AU - Alhazzani,Waleed, AU - Evans,Laura, AU - Alshamsi,Fayez, AU - Møller,Morten Hylander, AU - Ostermann,Marlies, AU - Prescott,Hallie C, AU - Arabi,Yaseen M, AU - Loeb,Mark, AU - Ng Gong,Michelle, AU - Fan,Eddy, AU - Oczkowski,Simon, AU - Levy,Mitchell M, AU - Derde,Lennie, AU - Dzierba,Amy, AU - Du,Bin, AU - Machado,Flavia, AU - Wunsch,Hannah, AU - Crowther,Mark, AU - Cecconi,Maurizio, AU - Koh,Younsuck, AU - Burry,Lisa, AU - Chertow,Daniel S, AU - Szczeklik,Wojciech, AU - Belley-Cote,Emilie, AU - Greco,Massimiliano, AU - Bala,Malgorzata, AU - Zarychanski,Ryan, AU - Kesecioglu,Jozef, AU - McGeer,Allison, AU - Mermel,Leonard, AU - Mammen,Manoj J, AU - Nainan Myatra,Sheila, AU - Arrington,Amy, AU - Kleinpell,Ruth, AU - Citerio,Giuseppe, AU - Lewis,Kimberley, AU - Bridges,Elizabeth, AU - Memish,Ziad A, AU - Hammond,Naomi, AU - Hayden,Frederick G, AU - Alshahrani,Muhammed, AU - Al Duhailib,Zainab, AU - Martin,Greg S, AU - Kaplan,Lewis J, AU - Coopersmith,Craig M, AU - Antonelli,Massimo, AU - Rhodes,Andrew, PY - 2021/2/9/pubmed PY - 2021/3/5/medline PY - 2021/2/8/entrez SP - e219 EP - e234 JF - Critical care medicine JO - Crit Care Med VL - 49 IS - 3 N2 - BACKGROUND: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU. METHODS: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. RESULTS: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning. CONCLUSION: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/33555780/Surviving_Sepsis_Campaign_Guidelines_on_the_Management_of_Adults_With_Coronavirus_Disease_2019__COVID_19__in_the_ICU:_First_Update_ DB - PRIME DP - Unbound Medicine ER -