Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19)

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 4 are best practice statements, 9 are strong recommendations, and 35 are weak recommendations. No recommendation was provided for 6 questions. The topics were: (1) infection control, (2) laboratory diagnosis and specimens, (3) hemodynamic support, (4) ventilatory support, and (5) COVID-19 therapy.Recommendation 9. For the acute resuscitation of adults with COVID-19 and shock, we suggest using a conservative over a liberal fluid strategy. Weak recommendation, low-quality evidence.

Coronavirus Disease (COVID-19): A primer for emergency physicians

“…64 If portable studies (e.g., plain radiography) cannot be completed within the patient's room or the patient requires transport elsewhere within the ED or hospital by wheelchair or stretcher, HCPs should don appropriate PPE. 64,70 Healthcare professionals at the destination or receiving location should be made aware of the patient's arrival and likewise don appropriate PPE. 64,71 Patients leaving their treatment room should wear a facemask, be dressed in a clean hospital gown (when possible), perform hand hygiene, and be educated in proper respiratory hygiene.…”

“…30,72 Rescue intubations should be avoided whenever possible as complete adherence to PPE respirator and placement of the patient in an AIIR. 70 Based on prior cases of HCPs infected with SARS-CoV while using N95 respirators, some experts recommend using a PAPR. 72 The most experienced provider should intubate.…”

“…72 The most experienced provider should intubate. 70,72 To reduce inadvertent contamination by touching one's face or hair, a full face shield and head cover is recommended if a PAPR is not used. 30,72 Wrist exposure can be minimized by using longer-sleeved gloves or vertically taping gloves to the gown.…”

“…72 Video laryngoscopy is preferred to direct laryngoscopy to increase distance between the intubator and the patient. 30,70 A closed system should be utilized for suctioning. Once the intubation is complete, the emergency physician should immediately place the laryngoscope in their outer glove along with all other equipment used for intubation in a double zip-locked plastic bag.…”

“…infection should be given supplementary oxygen to maintain an oxygenation saturation ≥90% but no higher than 96%. 62,70 Up to 76% of patients require oxygen therapy. 40 intubation should be performed.…”