Prashant Nasa1, Elie Azoulay2, Ashish K Khanna3, Ravi Jain4, Sachin Gupta5, Yash Javeri6, Deven Juneja7, Pradeep Rangappa8, Krishnaswamy Sundararajan9, Waleed Alhazzani10, Massimo Antonelli11, Yaseen M Arabi12, Jan Bakker13,14,15, Laurent J Brochard16, Adam M Deane17, Bin Du18, Sharon Einav19, Andrés Esteban20, Ognjen Gajic21, Samuel M Galvagno22, Claude Guérin23,24, Samir Jaber25,26, Gopi C Khilnani27, Younsuck Koh28, Jean-Baptiste Lascarrou29, Flavia R Machado30, Manu L N G Malbrain31,32, Jordi Mancebo33, Michael T McCurdy34, Brendan A McGrath35,36, Sangeeta Mehta37, Armand Mekontso-Dessap38, Mervyn Mer39, Michael Nurok40, Pauline K Park41, Paolo Pelosi42,43, John V Peter44, Jason Phua45, David V Pilcher46, Lise Piquilloud47, Peter Schellongowski48, Marcus J Schultz49,50,51, Manu Shankar-Hari52,53, Suveer Singh54, Massimiliano Sorbello55, Ravindranath Tiruvoipati56, Andrew A Udy57, Tobias Welte58, Sheila N Myatra59. 1. Critical Care Medicine, NMC Speciality Hospital, Dubai, United Arab Emirates. 2. Saint-Louis teaching hospital - APHP - and University of Paris, Paris, France. 3. Wake Forest University School of Medicine, Winston-Salem, NC and Outcomes Research Consortium , Cleveland, USA. 4. Mahatma Gandhi Medical College and Hospital, Jaipur, India. 5. Narayana Super Speciality Hospital, Gurugram, India. 6. Regency Super Speciality Hospital, Lucknow, India. 7. Max Super Speciality Hospital, New Delhi, India. 8. Columbia Asia Referral Hospital, Bengaluru, India. 9. Royal Adelaide Hospital and The University of Adelaide, Adelaide, Australia. 10. McMaster University, Hamilton, Canada. 11. Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy. 12. King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia. 13. New York University School of Medicine and Columbia University College of Physicians & Surgeons, New York, USA. 14. Erasmus MC University Medical Center, Rotterdam, The Netherlands. 15. Pontificia Universidad Catolica de Chile, Santiago, Chile. 16. Keenan Research Centre, Li Ka Shing Knowledge Institute, St Michael's Hospital, Unity Health Toronto, and University of Toronto, Toronto, Canada. 17. Royal Melbourne Hospital and The University of Melbourne, Melbourne, Australia. 18. Peking Union Medical College Hospital, Peking, China. 19. The Shaare Zedek Medical Center, Jerusalem, Israel. 20. Hospital Universitario de Getafe, CIBER de Enfermedades Respiratorias, Madrid, Spain. 21. Mayo Clinic, Maryland, USA. 22. University of Maryland, Maryland, USA. 23. University de Lyon, Lyon, France. 24. Institut Mondor de Recherches Biomédicales, Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon, Créteil, France. 25. Montpellier University Hospital, Montpellier, France. 26. Hôpital Saint-Éloi, CHU de Montpellier, Phy Med Exp, Université de Montpellier, Montpellier, France. 27. PSRI Hospital, New Delhi, India. 28. Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea. 29. Nantes University Hospital, Nantes, France. 30. Federal University of São Paulo, São Paulo, Brazil. 31. International Fluid Academy, Lovenjoel, Belgium. 32. Faculty of Engineering, Department of Electronics and Informatics, Vrije Universiteit Brussel (VUB), Brussels, Belgium. 33. Hospital Universitari Sant Pau, Barcelona, Spain. 34. University of Maryland School of Medicine, Maryland, USA. 35. Manchester University NHS Foundation Trust, Manchester, UK. 36. Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, Faculty of Biology Medicine and Health, University of Manchester, Academic Health Sciences Centre, Manchester, UK. 37. Sinai Health and the University of Toronto, Toronto, Canada. 38. Assistance Publique - Hôpitaux de Paris, Hôpitaux Universitaires Henri-Mondor, Service de Medicine Intensive Réanimation, and Univ Paris Est Créteil, CARMAS, Créteil, France. 39. Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. 40. Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, USA. 41. University of Michigan, Ann Arbor, USA. 42. San Martino Policlinico Hospital, IRCCS for Oncology and Neurosciences , Genoa, Italy. 43. Department of Surgical Sciences and Integrated Sciences, University of Genoa , Genoa, Italy. 44. Christian Medical College, Vellore, India. 45. Alexandra Hospital and National University Hospital, Singapore, Singapore. 46. Alfred Health, and Monash University, Melbourne, Australia. 47. Lausanne University Hospital and Lausanne University, Lausanne, Switzerland. 48. Medical University of Vienna, Vienna, Austria. 49. Amsterdam University Medical Center, Amsterdam, The Netherlands. 50. Mahidol University, Bangkok, Thailand. 51. University of Oxford, Oxford, UK. 52. Guy's and St Thomas' NHS Foundation Trust, London, UK. 53. King's College London, London, UK. 54. Royal Brompton Hospital and Chelsea and Westminster Hospital, Imperial College, London, UK. 55. Anesthesia and Intensive Care , AOU Policlinico - San Marco, Catania, Italy. 56. Peninsula Health and Monash University, Melbourne, Australia. 57. Monash University, Melbourne, Australia. 58. Department of Respiratory Medicine, German Centre of Lung Research, Hannover, Germany. 59. Department of Anaesthesia, Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute, Dr. Ernest Borges Road, Parel, Mumbai, India. sheila150@hotmail.com.
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 (χ2) 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.
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 (χ2) 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-19patients. 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.
Authors: Eddy Fan; Jeremy R Beitler; Laurent Brochard; Carolyn S Calfee; Niall D Ferguson; Arthur S Slutsky; Daniel Brodie Journal: Lancet Respir Med Date: 2020-07-06 Impact factor: 30.700
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Authors: Friedrich Hohmann; Lisa Wedekind; Felicitas Grundeis; Steffen Dickel; Johannes Frank; Martin Golinski; Mirko Griesel; Clemens Grimm; Cindy Herchenhahn; Andre Kramer; Maria-Inti Metzendorf; Onnen Moerer; Nancy Olbrich; Volker Thieme; Astrid Vieler; Falk Fichtner; Jacob Burns; Sven Laudi Journal: Cochrane Database Syst Rev Date: 2022-06-29
Authors: Emma J Perkins; Jonathan L Begley; Fiona M Brewster; Nathan D Hanegbi; Arun A Ilancheran; David J Brewster Journal: PLoS One Date: 2022-10-20 Impact factor: 3.752
Authors: Stephan Ehrmann; Jie Li; Miguel Ibarra-Estrada; Yonatan Perez; Ivan Pavlov; Bairbre McNicholas; Oriol Roca; Sara Mirza; David Vines; Roxana Garcia-Salcido; Guadalupe Aguirre-Avalos; Matthew W Trump; Mai-Anh Nay; Jean Dellamonica; Saad Nseir; Idrees Mogri; David Cosgrave; Dev Jayaraman; Joan R Masclans; John G Laffey; Elsa Tavernier Journal: Lancet Respir Med Date: 2021-08-20 Impact factor: 30.700
Authors: Denise Battaglini; Chiara Robba; Lorenzo Ball; Pedro L Silva; Fernanda F Cruz; Paolo Pelosi; Patricia R M Rocco Journal: Br J Anaesth Date: 2021-06-03 Impact factor: 11.719
Authors: Peter Thomas; Claire Baldwin; Lisa Beach; Bernie Bissett; Ianthe Boden; Sherene Magana Cruz; Rik Gosselink; Catherine L Granger; Carol Hodgson; Anne E Holland; Alice Ym Jones; Michelle E Kho; Lisa van der Lee; Rachael Moses; George Ntoumenopoulos; Selina M Parry; Shane Patman Journal: J Physiother Date: 2021-12-23 Impact factor: 7.000