Dataset Information

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

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.

SUBMITTER: Nasa P

PROVIDER: S-EPMC7962430 | biostudies-literature | 2021 Mar

REPOSITORIES: biostudies-literature

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Publications

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

Nasa Prashant P Azoulay Elie E Khanna Ashish K AK Jain Ravi R Gupta Sachin S Javeri Yash Y Juneja Deven D Rangappa Pradeep P Sundararajan Krishnaswamy K Alhazzani Waleed W Antonelli Massimo M Arabi Yaseen M YM Bakker Jan J Brochard Laurent J LJ Deane Adam M AM Du Bin B Einav Sharon S Esteban Andrés A Gajic Ognjen O Galvagno Samuel M SM Guérin Claude C Jaber Samir S Khilnani Gopi C GC Koh Younsuck Y Lascarrou Jean-Baptiste JB Machado Flavia R FR Malbrain Manu L N G MLNG Mancebo Jordi J McCurdy Michael T MT McGrath Brendan A BA Mehta Sangeeta S Mekontso-Dessap Armand A Mer Mervyn M Nurok Michael M Park Pauline K PK Pelosi Paolo P Peter John V JV Phua Jason J Pilcher David V DV Piquilloud Lise L Schellongowski Peter P Schultz Marcus J MJ Shankar-Hari Manu M Singh Suveer S Sorbello Massimiliano M Tiruvoipati Ravindranath R Udy Andrew A AA Welte Tobias T Myatra Sheila N SN

Critical care (London, England) 20210316 1

<h4>Background</h4>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.<h4>Methods</h4>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. Agre ...[more]

PMID: 33726819

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Dataset Information

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

Background

Methods

Results

Conclusion

Trial registration

Publications

Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method.

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