Critical Care for COVID-19 Affected Patients: Updated Position Statement of the Indian Society of Critical Care Medicine

Abstract

A bstract The management of coronavirus disease-2019 (COVID-19) is witnessing a change as we learn more about the pathophysiology and the severity of the disease. Several randomized controlled trials (RCTs) and meta-analysis have been published over the last few months. Several interventions and therapies which showed promise in the initial days of the pandemic have subsequently failed to show benefit in well-designed trials. Understanding of the methods of oxygen delivery and ventilation have also evolved over the past few months. The Indian Society of Critical Care Medicine (ISCCM) has reviewed the evidence that has emerged since the publication of its position statement in May and has put together an addendum of updated evidence. How to cite this article: Mehta Y, Chaudhry D, Abraham OC, Chacko J, Divatia J, Jagiasi B, et al . Critical Care for COVID-19 Affected Patients: Position Statement of the Indian Society of Critical Care Medicine. Indian J Crit Care Med 2020;24(Suppl 5):S225–S230.

Adherence of Clinical Practice Guidelines for Pharmacologic Treatments of Hospitalized Patients With COVID-19 to Trustworthy Standards

“…From 2226 citations, the reviewers screened 51 full texts and identified 32 eligible CPGs. 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 We excluded 19 CPGs (eFigure in Supplement 1 ). 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Of the 32 included CPGs, 3 (9.4%) 15 , 38 , 40 reported on pharmacologic treatments for critically ill patients specifically, and the remainder reported on treatments for hospitalized patients with COVID-19.…”

“…Fifteen CPGs (46.9%) were international 15 , 16 , 20 , 21 , 23 , 24 , 27 , 31 , 32 , 33 , 34 , 36 , 38 , 43 , 44 and 17 (53.1%) were national. 13 , 14 , 17 , 18 , 19 , 22 , 25 , 26 , 28 , 29 , 30 , 35 , 37 , 39 , 40 , 41 , 42 Most CPGs (25 [78.1%]) had sponsorship from 1 or more national societies, and few CPGs (3 [9.4%]) 14 , 23 , 34 had sponsorship from government, nongovernment, or not-for-profit agencies (4 [12.5%]). 13 , 32 , 38 , 44 Seven CPGs (21.9%) 13 , 20 , 23 , 30 , 31 , 32 , 34 explicitly reported their funding sources (eTable 1 in Supplement 1 ).…”

“…Eighteen CPGs (56.3%) explicitly disclosed funding information. 13 , 15 , 18 , 20 , 21 , 22 , 23 , 24 , 26 , 27 , 30 , 31 , 32 , 34 , 38 , 39 , 42 , 44 Twenty CPGs (62.5%) 13 , 15 , 17 , 18 , 20 , 21 , 23 , 24 , 27 , 28 , 29 , 30 , 32 , 34 , 35 , 37 , 38 , 40 , 43 , 44 included multidisciplinary guideline panels, and 5 guideline panels (15.6%) 13 , 15 , 32 , 34 , 44 included a methodologist.…”

“…Five CPGs (15.6%) 15 , 27 , 32 , 34 , 44 adhered (score of 4 or 5) to the standard to rate the strength of the recommendations (strong or conditional/weak) based on a clear and well-described evidence-to-recommendation scheme that took into account the balance between benefits and harms, available evidence, and their confidence in the underlying evidence (quantity, quality, and consistency). Fourteen CPGs (43.8%) 15 , 18 , 20 , 22 , 23 , 24 , 26 , 27 , 30 , 32 , 34 , 36 , 39 , 44 adhered (score of 4 or 5) to the requirement to make specific and unambiguous recommendations that stated which actions should or should not be taken in specific situations or populations, and, where recommendations were vague or underspecified, clearly described the rationale for making recommendations.…”

“…13,32,38,44 Seven CPGs (21.9%) 13,20,23,[30][31][32]34 explicitly reported their funding sources (eTable 1 in Supplement 1). Guidelines predominantly included authors from a single WHO region (20 [62.5%]) and mostly emanated from America or 2 0 2 0 B e r l i t e t a l , 4 2 2 0 2 0 C h a w la e t a l, M e h t a e t a l, 1 9 2 0 2 0 M eh ta et al , 39 2 0 2 0 Moo res et al, 27 Different colors reflect the various components of the National Academy of Medicine (NAM) score. Higher rays represent higher-quality scores as assessed using the NEATS instrument, which measures adherence (on a scale ranging from 1 [low adherence] to 5…”