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Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in
You Shang1, Chun Pan2, Xianghong Yang3
1Department of Critical Care Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Insights
Expert consensus provides guidance for managing critically ill patients with coronavirus disease 2019 (COVID-19). Recommendations cover personnel protection, organ support, and therapies, emphasizing dynamic monitoring and supportive care due to lack of targeted treatments.
Area of Science:
- Intensive Care Medicine
- Infectious Diseases
- Critical Care
Background:
- The COVID-19 pandemic has overwhelmed critical care resources globally.
- Urgent need for expert guidance on managing severe COVID-19 cases.
Purpose of the Study:
- To develop evidence-based and expert-opinion recommendations for the critical care of COVID-19 patients.
- To provide trustworthy guidance for front-line medical personnel.
Main Methods:
- A Delphi-like method involving 5 rounds of expert seminars and discussions.
- 16 front-line critical care experts in China contributed based on their expertise.
- Statements were developed using available clinical evidence and expert consensus.
Main Results:
- A comprehensive document with 46 statements on COVID-19 critical care was generated.
- Recommendations included personnel protection, etiological treatment, organ support, and patient transport.
- 5 strong recommendations (Grade 1), 21 weak recommendations (Grade 2), and 20 expert opinions were established with strong agreement.
Conclusions:
- No targeted therapies are currently available for COVID-19.
- Dynamic monitoring and supportive treatment are crucial for organ function recovery.
- Expert consensus provides essential guidance for critical care management during the pandemic.
Background:
The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed.
Methods:
Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences.
Results:
A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations.
Conclusion:
There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.
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