The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

Abstract

Background The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). Methods The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. Results The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. Conclusion The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Clinical characteristics and outcome of Covid-19 illness and predictors of in-hospital mortality in Saudi Arabia

“…In our study, the old age of 70 or more was the only significant personal factor associated with in-hospital mortality among hospitalized Covid-19 patients. Older patients showed higher tendency to progress to severe Covid-1 9 illness than relatively younger patients [ 21 ], and this was attributed to functional defects in immune cells, leading to inability to suppress viral replication, as age advances [ 45 – 47 ]. In our study, age of > 64 was the significant cut-off age for the prediction of in-hospital mortality from Covid-19.…”

“…Recommendations for adult patients admitted to the ICU include antiviral therapy, Immunomodulation therapy, and corticosteroids. Dexamethasone over other corticosteroids is also suggested [ 21 ].…”

A comparison of three thromboprophylaxis regimens in critically ill COVID-19 patients: An analysis of real-world data

“…The American Society of Hematology guidelines and Saudi Critical Care Society practice guidelines suggest using the standard prophylactic dose for adults with critical COVID-19 who had no clinical suspicion of VTE ( 72 , 73 ). However, our findings may counter the uncertainty about using standard prophylactic dose in patients with high suspicion of VTE, namely those with D-dimer level >1.5 μg/ml (in >60% of our cohort).…”

Infectious diseases pharmacy practice, education, and research in Saudi Arabia: A review and future perspectives by the Infectious Diseases Pharmacy Specialty Network at the Saudi Society of Clinical Pharmacy

“…Although ID pharmacists are actively involved in observational studies, prospective interventional studies should not be overlooked. Notably, ID pharmacists are involved in clinical practice guidelines development given they are pharmacy expertise ( Alhazzani et al, 2022 ). Moreover, ID pharmacists can publish ASP research discussing their experience in establishing these programs and implementing the ASP interventions, as well as evaluating the outcomes of ASPs.…”