Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Nasa, Prashant (Critical Care Medicine. NMC Speciality Hospital)
Azoulay, Elie (Saint-Louis teaching hospital - APHP - and University of Paris)
Khanna, Ashish K. (Wake Forest University School of Medicine. Winston-Salem. NC and Outcomes Research Consortium)
Jain, Ravi (Mahatma Gandhi Medical College and Hospital)
Gupta, Sachin (Narayana Super Speciality Hospital)
Javeri, Yash (Regency Super Speciality Hospital)
Juneja, Deven (Max Super Speciality Hospital)
Rangappa, Pradeep (Columbia Asia Referral Hospital)
Sundararajan, Krishnaswamy (Royal Adelaide Hospital and The University of Adelaide)
Alhazzani, Waleed (McMaster University (Canadà))
Antonelli, Massimo (Fondazione Policlinico Universitario A. Gemelli IRCCS)
Arabi, Y (King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Centre)
Bakker, Jan (Pontificia Universidad Católica de Chile)
Brochard, Laurent (Keenan Research Centre. Li Ka Shing Knowledge Institute. St Michael's Hospital. Unity Health Toronto. and University of Toronto)
Deane, Adam M. (Royal Melbourne Hospital and The University of Melbourne)
Du, Bin (Peking Union Medical College Hospital)
Einav, Sharon (The Shaare Zedek Medical Center)
Esteban, Andrés (Hospital Universitario de Getafe (Madrid))
Gajic, Ognjen (Mayo Clinic)
Galvagno Jr., Samuel M. (University of Maryland)
Guérin, Claude (Institut Mondor de Recherches Biomédicales. Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon. and Medecine Intensive Réanimation Hôpital Edouard Herriot Lyon)
Jaber, Samir (Hôpital Saint-Éloi. CHU de Montpellier. Phy Med Exp. Université de Montpellier)
Khilnani, Gopi C. (PSRI Hospital)
Koh, Younsuck (Asan Medical Center. University of Ulsan College of Medicine)
Lascarrou, Jean Baptiste (CHU de Nantes)
Machado, Flavia R. (Federal University of São Paulo)
Malbrain, Manu L.N.G. (Faculty of Engineering. Department of Electronics and Informatics. Vrije Universiteit Brussel (VUB))
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
McCurdy, Michael T. (University of Maryland School of Medicine)
McGrath, Brendan A. (Division of Infection. Immunity and Respiratory Medicine. School of Biological Sciences. Faculty of Biology Medicine and Health. University of Manchester. Academic Health Sciences Centre)
Mehta, Sangeeta (Sinai Health and the University of Toronto)
Mekontso-Dessap, Armand (Assistance Publique - Hôpitaux de Paris. Hôpitaux Universitaires Henri-Mondor. Service de Medicine Intensive Réanimation. and Univ Paris Est Créteil. CARMAS)
Mer, Mervyn (Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences. University of the Witwatersrand)
Nurok, Michael (Cedars-Sinai Medical Center. Smidt Heart Institute)
Park, Pauline K. (University of Michigan)
Pelosi, Paolo (Università degli Studi di Genova. Dipartimento Scienze Chirurgiche e Diagnostiche Integrate (DISC))
Peter, John V. (Christian Medical College)
Phua, Jason (Alexandra Hospital and National University Hospital)
Pilcher, David V. (Alfred Health. and Monash University)
Piquilloud, Lise (Lausanne University Hospital)
Schellongowski, Peter (Medical University of Vienna)
Schultz, Marcus J. (University of Oxford)
Shankar-Hari, Manu (King's College London)
Singh, Suveer (Royal Brompton Hospital and Chelsea and Westminster Hospital. Imperial College)
Sorbello, Massimiliano (Anesthesia and Intensive Care. AOU Policlinico - San Marco)
Tiruvoipati, Ravindranath (Peninsula Health and Monash University)
Udy, Andrew A. (Monash University)
Welte, Tobias (Department of Respiratory Medicine. German Centre of Lung Research)
Myatra, Sheila N. (Department of Anaesthesia. Critical Care and Pain. Tata Memorial Hospital. Homi Bhabha National Institute)

Fecha:	2021
Resumen:	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 (χ) 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.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Respiratory distress syndrome adult ; COVID-19 ventilatory management ; COVID-19 respiratory management ; COVID-19 acute respiratory distress syndrome ; COVID-19 high fow nasal oxygen ; COVID 19 invasive mechanical ventilation
Publicado en:	Critical Care, Vol. 25 Núm. 1 (december 2021) , p. 106, ISSN 1466-609X

DOI: 10.1186/s13054-021-03491-y
PMID: 33726819

17 p, 1.6 MB

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