Objective: To communicate interim guidelines on the acute management of critically ill patients with severe illness due to coronavirus disease of 2019 (COVID-19).
This guideline is intended to support hospital clinicians in managing critically ill adults with COVID-19 in the intensive care unit (ICU). The target users of this guideline are frontline clinicians, allied health professionals, and policymakers. The guidelines can be applied to both high and low-middle income settings.
A panel of 36 experts from 12 countries proposed 53 questions, relevant to the management of COVID-19 in the ICU. Literature search identified relevant and recent systematic reviews on most questions related to the supportive care.
The panel included experts in guideline development, infection control, infectious diseases and microbiology, critical care, emergency medicine, nursing, and public health. The panel was divided into five groups:
- Infection control- For performing aerosol-generating procedures, use fitted respirator masks (N95 respirators, FFP2, or equivalent)
- Laboratory diagnosis and specimens- Obtain lower respiratory tract samples instead of upper respiratory tract samples as endotracheal aspirates instead of bronchoalveolar lavage samples. This should be done by the healthcare worker who is most experienced with airway management in order to minimize the number of attempts and risk of transmission.
- Hemodynamic support- For acute resuscitation of adults with COVID-19 and shock, do not use hydroxyethyl starches.
- Ventilatory support- Start supplemental oxygen if the peripheral oxygen saturation (SpO2) is < 92%, and also start supplemental oxygen if SpO2 is < 90%.
- COVID-19 therapy- In mechanically ventilated adults with COVID-19 and with acute respiratory distress syndrome, use systemic corticosteroids.
Reference: Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al., Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2020 Mar 28. doi: 10.1007/s00134-020-06022-5.