tetano
Editor, Senior Moderator
Crit Care
. 2021 Mar 16;25(1):106.
doi: 10.1186/s13054-021-03491-y.
Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Prashant Nasa[SUP] 1 [/SUP], Elie Azoulay[SUP] 2 [/SUP], Ashish K Khanna[SUP] 3 [/SUP], Ravi Jain[SUP] 4 [/SUP], Sachin Gupta[SUP] 5 [/SUP], Yash Javeri[SUP] 6 [/SUP], Deven Juneja[SUP] 7 [/SUP], Pradeep Rangappa[SUP] 8 [/SUP], Krishnaswamy Sundararajan[SUP] 9 [/SUP], Waleed Alhazzani[SUP] 10 [/SUP], Massimo Antonelli[SUP] 11 [/SUP], Yaseen M Arabi[SUP] 12 [/SUP], Jan Bakker[SUP] 13 14 15 [/SUP], Laurent J Brochard[SUP] 16 [/SUP], Adam M Deane[SUP] 17 [/SUP], Bin Du[SUP] 18 [/SUP], Sharon Einav[SUP] 19 [/SUP], Andr?s Esteban[SUP] 20 [/SUP], Ognjen Gajic[SUP] 21 [/SUP], Samuel M Galvagno Jr[SUP] 22 [/SUP], Claude Gu?rin[SUP] 23 24 [/SUP], Samir Jaber[SUP] 25 26 [/SUP], Gopi C Khilnani[SUP] 27 [/SUP], Younsuck Koh[SUP] 28 [/SUP], Jean-Baptiste Lascarrou[SUP] 29 [/SUP], Flavia R Machado[SUP] 30 [/SUP], Manu L N G Malbrain[SUP] 31 32 [/SUP], Jordi Mancebo[SUP] 33 [/SUP], Michael T McCurdy[SUP] 34 [/SUP], Brendan A McGrath[SUP] 35 36 [/SUP], Sangeeta Mehta[SUP] 37 [/SUP], Armand Mekontso-Dessap[SUP] 38 [/SUP], Mervyn Mer[SUP] 39 [/SUP], Michael Nurok[SUP] 40 [/SUP], Pauline K Park[SUP] 41 [/SUP], Paolo Pelosi[SUP] 42 43 [/SUP], John V Peter[SUP] 44 [/SUP], Jason Phua[SUP] 45 [/SUP], David V Pilcher[SUP] 46 [/SUP], Lise Piquilloud[SUP] 47 [/SUP], Peter Schellongowski[SUP] 48 [/SUP], Marcus J Schultz[SUP] 49 50 51 [/SUP], Manu Shankar-Hari[SUP] 52 53 [/SUP], Suveer Singh[SUP] 54 [/SUP], Massimiliano Sorbello[SUP] 55 [/SUP], Ravindranath Tiruvoipati[SUP] 56 [/SUP], Andrew A Udy[SUP] 57 [/SUP], Tobias Welte[SUP] 58 [/SUP], Sheila N Myatra[SUP] 59 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice.
Methods: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (?[SUP]2[/SUP]) test (p < 0?05 was considered as unstable).
Results: Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment.
Conclusion: Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited.
Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.
Keywords: COVID 19 invasive mechanical ventilation; COVID-19 acute respiratory distress syndrome; COVID-19 high flow nasal oxygen; COVID-19 respiratory management; COVID-19 ventilatory management; Respiratory distress syndrome adult.
. 2021 Mar 16;25(1):106.
doi: 10.1186/s13054-021-03491-y.
Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Prashant Nasa[SUP] 1 [/SUP], Elie Azoulay[SUP] 2 [/SUP], Ashish K Khanna[SUP] 3 [/SUP], Ravi Jain[SUP] 4 [/SUP], Sachin Gupta[SUP] 5 [/SUP], Yash Javeri[SUP] 6 [/SUP], Deven Juneja[SUP] 7 [/SUP], Pradeep Rangappa[SUP] 8 [/SUP], Krishnaswamy Sundararajan[SUP] 9 [/SUP], Waleed Alhazzani[SUP] 10 [/SUP], Massimo Antonelli[SUP] 11 [/SUP], Yaseen M Arabi[SUP] 12 [/SUP], Jan Bakker[SUP] 13 14 15 [/SUP], Laurent J Brochard[SUP] 16 [/SUP], Adam M Deane[SUP] 17 [/SUP], Bin Du[SUP] 18 [/SUP], Sharon Einav[SUP] 19 [/SUP], Andr?s Esteban[SUP] 20 [/SUP], Ognjen Gajic[SUP] 21 [/SUP], Samuel M Galvagno Jr[SUP] 22 [/SUP], Claude Gu?rin[SUP] 23 24 [/SUP], Samir Jaber[SUP] 25 26 [/SUP], Gopi C Khilnani[SUP] 27 [/SUP], Younsuck Koh[SUP] 28 [/SUP], Jean-Baptiste Lascarrou[SUP] 29 [/SUP], Flavia R Machado[SUP] 30 [/SUP], Manu L N G Malbrain[SUP] 31 32 [/SUP], Jordi Mancebo[SUP] 33 [/SUP], Michael T McCurdy[SUP] 34 [/SUP], Brendan A McGrath[SUP] 35 36 [/SUP], Sangeeta Mehta[SUP] 37 [/SUP], Armand Mekontso-Dessap[SUP] 38 [/SUP], Mervyn Mer[SUP] 39 [/SUP], Michael Nurok[SUP] 40 [/SUP], Pauline K Park[SUP] 41 [/SUP], Paolo Pelosi[SUP] 42 43 [/SUP], John V Peter[SUP] 44 [/SUP], Jason Phua[SUP] 45 [/SUP], David V Pilcher[SUP] 46 [/SUP], Lise Piquilloud[SUP] 47 [/SUP], Peter Schellongowski[SUP] 48 [/SUP], Marcus J Schultz[SUP] 49 50 51 [/SUP], Manu Shankar-Hari[SUP] 52 53 [/SUP], Suveer Singh[SUP] 54 [/SUP], Massimiliano Sorbello[SUP] 55 [/SUP], Ravindranath Tiruvoipati[SUP] 56 [/SUP], Andrew A Udy[SUP] 57 [/SUP], Tobias Welte[SUP] 58 [/SUP], Sheila N Myatra[SUP] 59 [/SUP]
Affiliations
- PMID: 33726819
- DOI: 10.1186/s13054-021-03491-y
Abstract
Background: Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice.
Methods: Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square (?[SUP]2[/SUP]) test (p < 0?05 was considered as unstable).
Results: Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16-24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment.
Conclusion: Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited.
Trial registration: The study was registered with Clinical trials.gov Identifier: NCT04534569.
Keywords: COVID 19 invasive mechanical ventilation; COVID-19 acute respiratory distress syndrome; COVID-19 high flow nasal oxygen; COVID-19 respiratory management; COVID-19 ventilatory management; Respiratory distress syndrome adult.