The SARS-CoV-2 Coronavirus is the cause of rapidly spreading illness, Coronavirus Disease 2019 COVID-19, which became a pandemic affecting 120,000 individuals in more than 80 countries around the world. Urgent guidance to clinicians caring for the sickest group of these patients is needed! The WHO and the United States CDC have issued preliminary guidance on infection control, screening and diagnosis in the general population, but there is limited guidance on the acute management of critically ills with severe illness due to COVID-19. The COVID-19 surviving sepsis campaign panel, including 36 experts in guideline development, infection control, infectious diseases and microbiology, critical care, emergency medicine, nursing, and public health, from 12 countries, issued several recommendations:
4 best practice statements
9 strong recommendations
34 weak recommendations
support clinicians, allied health professionals, involved policymakers; some guidance to HCWs in low-middle income setting is provided. GRADE approach has been used to assess the quality of evidence. No recommendation feasible for 6 questions. Given the recent emergence of COVID-19, with consideration for limited direct evidence actually existing, indirect evidence on MERS-CoV, SARS-CoV-1, and other coronaviruses, and indirect evidence related to supportive care in ICU from studies on influenza and other respiratory viral infections, ARDS and sepsis has been applied. As relevant new evidence will emerges, it will be used by the panel to update the recommendations as needed, or formulate new recommendations, in what is known as a “living guideline” model.
Full text available, open access link.
As emerging, relevant new evidence as it emerges will be used by the panel to update the recommendations as needed, or formulate new recommendations, in what is known as a “living guideline” model.
Here a series of graphic summaries by Marta Velia Antonini @FOAMecmo
First one, on recommendations on infection Control, diagnosis & testing.
Hemodynamic support: monitoring, fluids & vasoactives.
Non-Invasive Ventilatory support in: SpO2 targets, conventional oxygen therapy, High Flow Nasal Cannula & Non-Invasive Positive Pressure Ventilation.
Invasive mechanical ventilation, recommendations on
neuro-muscolare blocking agents
Recommendations on therapy: steroids, antipyretics, antivirals, IVIg, convalescent plasma, rIFNs chloroquine, tocilizumab & more!