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

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dc.contributor.authorNasa, Prashant
dc.contributor.authorAzoulay, Elie
dc.contributor.authorKhanna, Ashish K.
dc.contributor.authorJain, Ravi
dc.contributor.authorGupta, Sachin
dc.contributor.authorJaveri, Yash
dc.contributor.authorJuneja, Deven
dc.contributor.authorRangappa, Pradeep
dc.contributor.authorSundararajan, Krishnaswamy
dc.contributor.authorBakker, Jan
dc.date.accessioned2021-03-23T12:11:37Z
dc.date.available2021-03-23T12:11:37Z
dc.date.issued2021
dc.date.updated2021-03-21T01:03:48Z
dc.description.abstractAbstract 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.
dc.format.extent17 páginas
dc.identifier.citationCritical Care. 2021 Mar 16;25(1):106
dc.identifier.doi10.1186/s13054-021-03491-y
dc.identifier.urihttps://doi.org/10.1186/s13054-021-03491-y
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/52757
dc.identifier.wosidWOS:000629994000002
dc.issue.numeroNo. 106
dc.language.isoen
dc.nota.accesoContenido completo
dc.pagina.final17
dc.pagina.inicio1
dc.revistaCritical Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectRespiratory distress syndrome adultes_ES
dc.subjectCOVID-19 ventilatory managementes_ES
dc.subjectCOVID-19 respiratory managementes_ES
dc.subjectCOVID-19 acute respiratory distress syndromees_ES
dc.subjectCOVID-19 high fow nasal oxygenes_ES
dc.subjectCOVID 19 invasive mechanical ventilationes_ES
dc.subject.ddc616.2414
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleExpert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi methodes_ES
dc.typeartículo
dc.volumenVol. 25
sipa.codpersvinculados1044227
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