João João Mendes1,2, José Artur Paiva3,4,5, Filipe Gonzalez1,6, Paulo Mergulhão1,4,7, Filipe Froes8, Roberto Roncon5, João Gouveia1,9. 1. Sociedade Portuguesa de Cuidados Intensivos - Lisboa, Portugal. 2. Serviço de Medicina Intensiva, Hospital Prof. Doutor Fernando da Fonseca EPE - Lisboa, Portugal. 3. Colégio da Especialidade de Medicina Intensiva, Ordem dos Médicos - Lisboa, Portugal. 4. Grupo de Infeção e Sépsis - Lisboa, Portugal. 5. Serviço de Medicina Intensiva, Centro Hospitalar Universitário de São João EPE, Faculdade de Medicina da Universidade do Porto - Porto, Portugal. 6. Serviço de Medicina Intensiva, Hospital Garcia de Orta EPE - Lisboa, Portugal. 7. Unidade de Cuidados Intensivos Polivalente, Hospital Lusíadas Porto - Porto, Portugal. 8. Unidade de Cuidados Intensivos Médico-Cirúrgicos, Hospital de Pulido Valente, Centro Hospitalar Universitário de Lisboa Norte EPE - Lisboa, Portugal. 9. Serviço de Medicina Intensiva, Centro Hospitalar Universitário de Lisboa Norte EPE - Lisboa, Portugal.
Abstract
INTRODUCTION: The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations. METHODS: A national panel of experts who declared that they had no conflicts of interest regarding the development of the recommendations was assembled. Operational questions were developed based on the PICO methodology, and a rapid systematic review was conducted by consulting different bibliographic sources. The panel determined the direction and strength of the recommendations using two Delphi rounds, conducted in accordance with the principles of the GRADE system. A strong recommendation received the wording "is recommended", and a weak recommendation was written as "is suggested." RESULTS: A total of 48 recommendations and 30 suggestions were issued, covering the following topics: diagnosis of SARS-CoV-2 infection, coinfection and superinfection; criteria for admission, cure and suspension of isolation; organization of services; personal protective equipment; and respiratory support and other specific therapies (antivirals, immunomodulators and anticoagulation). CONCLUSION: These recommendations, specifically oriented to the Portuguese reality but that may also apply to Portuguese-speaking African countries and East Timor, aim to support health professionals in the management of critically ill patients with COVID-19. They will be continuously reviewed to reflect the progress of our understanding and the treatment of this pathology.
INTRODUCTION: The Sociedade Portuguesa de Cuidados Intensivos and the Infection and Sepsis Group have previously issued health service and management recommendations for critically ill patients with COVID-19. Due to the evolution of knowledge, the panel of experts was again convened to review the current evidence and issue updated recommendations. METHODS: A national panel of experts who declared that they had no conflicts of interest regarding the development of the recommendations was assembled. Operational questions were developed based on the PICO methodology, and a rapid systematic review was conducted by consulting different bibliographic sources. The panel determined the direction and strength of the recommendations using two Delphi rounds, conducted in accordance with the principles of the GRADE system. A strong recommendation received the wording "is recommended", and a weak recommendation was written as "is suggested." RESULTS: A total of 48 recommendations and 30 suggestions were issued, covering the following topics: diagnosis of SARS-CoV-2 infection, coinfection and superinfection; criteria for admission, cure and suspension of isolation; organization of services; personal protective equipment; and respiratory support and other specific therapies (antivirals, immunomodulators and anticoagulation). CONCLUSION: These recommendations, specifically oriented to the Portuguese reality but that may also apply to Portuguese-speaking African countries and East Timor, aim to support health professionals in the management of critically ill patients with COVID-19. They will be continuously reviewed to reflect the progress of our understanding and the treatment of this pathology.
Authors: E J Williams; L Mair; T I de Silva; D J Green; P House; K Cawthron; C Gillies; J Wigfull; H Parsons; D G Partridge Journal: J Hosp Infect Date: 2021-01-20 Impact factor: 3.926
Authors: Anthony C Gordon; Paul R Mouncey; Farah Al-Beidh; Kathryn M Rowan; Alistair D Nichol; Yaseen M Arabi; Djillali Annane; Abi Beane; Wilma van Bentum-Puijk; Lindsay R Berry; Zahra Bhimani; Marc J M Bonten; Charlotte A Bradbury; Frank M Brunkhorst; Adrian Buzgau; Allen C Cheng; Michelle A Detry; Eamon J Duffy; Lise J Estcourt; Mark Fitzgerald; Herman Goossens; Rashan Haniffa; Alisa M Higgins; Thomas E Hills; Christopher M Horvat; Francois Lamontagne; Patrick R Lawler; Helen L Leavis; Kelsey M Linstrum; Edward Litton; Elizabeth Lorenzi; John C Marshall; Florian B Mayr; Daniel F McAuley; Anna McGlothlin; Shay P McGuinness; Bryan J McVerry; Stephanie K Montgomery; Susan C Morpeth; Srinivas Murthy; Katrina Orr; Rachael L Parke; Jane C Parker; Asad E Patanwala; Ville Pettilä; Emma Rademaker; Marlene S Santos; Christina T Saunders; Christopher W Seymour; Manu Shankar-Hari; Wendy I Sligl; Alexis F Turgeon; Anne M Turner; Frank L van de Veerdonk; Ryan Zarychanski; Cameron Green; Roger J Lewis; Derek C Angus; Colin J McArthur; Scott Berry; Steve A Webb; Lennie P G Derde Journal: N Engl J Med Date: 2021-02-25 Impact factor: 91.245
Authors: Ryan M Brown; Li Wang; Taylor D Coston; Nathan I Krishnan; Jonathan D Casey; Jonathan P Wanderer; Jesse M Ehrenfeld; Daniel W Byrne; Joanna L Stollings; Edward D Siew; Gordon R Bernard; Wesley H Self; Todd W Rice; Matthew W Semler Journal: Am J Respir Crit Care Med Date: 2019-12-15 Impact factor: 21.405