Publication: Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Issued Date
2021-12-01
Resource Type
ISSN
1466609X
13648535
13648535
Other identifier(s)
2-s2.0-85103144157
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Mahidol University
Rights Holder(s)
SCOPUS
Bibliographic Citation
Critical Care. Vol.25, No.1 (2021)
Suggested Citation
Prashant Nasa, Elie Azoulay, Ashish K. Khanna, Ravi Jain, Sachin Gupta, Yash Javeri, Deven Juneja, Pradeep Rangappa, Krishnaswamy Sundararajan, Waleed Alhazzani, Massimo Antonelli, Yaseen M. Arabi, Jan Bakker, Laurent J. Brochard, Adam M. Deane, Bin Du, Sharon Einav, Andrés Esteban, Ognjen Gajic, Samuel M. Galvagno, Claude Guérin, Samir Jaber, Gopi C. Khilnani, Younsuck Koh, Jean Baptiste Lascarrou, Flavia R. Machado, Manu L.N.G. Malbrain, Jordi Mancebo, Michael T. McCurdy, Brendan A. McGrath, Sangeeta Mehta, Armand Mekontso-Dessap, Mervyn Mer, Michael Nurok, Pauline K. Park, Paolo Pelosi, John V. Peter, Jason Phua, David V. Pilcher, Lise Piquilloud, Peter Schellongowski, Marcus J. Schultz, Manu Shankar-Hari, Suveer Singh, Massimiliano Sorbello, Ravindranath Tiruvoipati, Andrew A. Udy, Tobias Welte, Sheila N. Myatra Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Critical Care. Vol.25, No.1 (2021). doi:10.1186/s13054-021-03491-y Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/77616
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Title
Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Author(s)
Prashant Nasa
Elie Azoulay
Ashish K. Khanna
Ravi Jain
Sachin Gupta
Yash Javeri
Deven Juneja
Pradeep Rangappa
Krishnaswamy Sundararajan
Waleed Alhazzani
Massimo Antonelli
Yaseen M. Arabi
Jan Bakker
Laurent J. Brochard
Adam M. Deane
Bin Du
Sharon Einav
Andrés Esteban
Ognjen Gajic
Samuel M. Galvagno
Claude Guérin
Samir Jaber
Gopi C. Khilnani
Younsuck Koh
Jean Baptiste Lascarrou
Flavia R. Machado
Manu L.N.G. Malbrain
Jordi Mancebo
Michael T. McCurdy
Brendan A. McGrath
Sangeeta Mehta
Armand Mekontso-Dessap
Mervyn Mer
Michael Nurok
Pauline K. Park
Paolo Pelosi
John V. Peter
Jason Phua
David V. Pilcher
Lise Piquilloud
Peter Schellongowski
Marcus J. Schultz
Manu Shankar-Hari
Suveer Singh
Massimiliano Sorbello
Ravindranath Tiruvoipati
Andrew A. Udy
Tobias Welte
Sheila N. Myatra
Elie Azoulay
Ashish K. Khanna
Ravi Jain
Sachin Gupta
Yash Javeri
Deven Juneja
Pradeep Rangappa
Krishnaswamy Sundararajan
Waleed Alhazzani
Massimo Antonelli
Yaseen M. Arabi
Jan Bakker
Laurent J. Brochard
Adam M. Deane
Bin Du
Sharon Einav
Andrés Esteban
Ognjen Gajic
Samuel M. Galvagno
Claude Guérin
Samir Jaber
Gopi C. Khilnani
Younsuck Koh
Jean Baptiste Lascarrou
Flavia R. Machado
Manu L.N.G. Malbrain
Jordi Mancebo
Michael T. McCurdy
Brendan A. McGrath
Sangeeta Mehta
Armand Mekontso-Dessap
Mervyn Mer
Michael Nurok
Pauline K. Park
Paolo Pelosi
John V. Peter
Jason Phua
David V. Pilcher
Lise Piquilloud
Peter Schellongowski
Marcus J. Schultz
Manu Shankar-Hari
Suveer Singh
Massimiliano Sorbello
Ravindranath Tiruvoipati
Andrew A. Udy
Tobias Welte
Sheila N. Myatra
Other Contributor(s)
Narayana Superspeciality Hospital, Gurugram
Faculty of Biology, Medicine and Health
Université Paris Cité
Manchester University NHS Foundation Trust
Université de Montpellier
IRCCS San Martino Polyclinic Hospital
Université de Lyon
King Saud bin Abdulaziz University for Health Sciences
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Erasmus MC
McMaster University
Centre Hospitalier Universitaire de Montpellier
Royal Adelaide Hospital
Wake Forest University School of Medicine
National University Hospital
Pontificia Universidad Católica de Chile
CHU de Nantes
University of Oxford
Vrije Universiteit Brussel
University of Michigan, Ann Arbor
Università degli Studi di Genova
Hôpital Henri Mondor
Centre Hospitalier Universitaire Vaudois
Shaare Zedek Medical Center
Monash University
Tata Memorial Hospital
Hopital Edouard Herriot
University of Toronto
University of the Witwatersrand, Johannesburg
Cedars-Sinai Medical Center
Universidade Federal de São Paulo
University of Maryland School of Medicine
Mahidol University
Hospital Universitari de Bellvitge
Vagelos College of Physicians and Surgeons
King's College London
Medizinische Universität Wien
Peking Union Medical College Hospital
University of Ulsan College of Medicine
Mayo Clinic
Guy's and St Thomas' NHS Foundation Trust
Royal Melbourne Hospital
Hospital Universitario de Getafe
Chelsea and Westminster Hospital
Amsterdam UMC - University of Amsterdam
Gandhi Medical College
Christian Medical College, Vellore
University of Maryland
A.O.U. Policlinico-San Marco
Regency Super Speciality Hospital
International Fluid Academy
German Center for Lung Research
Max Super Speciality Hospital
Columbia Asia Referral Hospital
PSRI Hospital
NMC Speciality Hospital
Faculty of Biology, Medicine and Health
Université Paris Cité
Manchester University NHS Foundation Trust
Université de Montpellier
IRCCS San Martino Polyclinic Hospital
Université de Lyon
King Saud bin Abdulaziz University for Health Sciences
Fondazione Policlinico Universitario Agostino Gemelli IRCCS
Erasmus MC
McMaster University
Centre Hospitalier Universitaire de Montpellier
Royal Adelaide Hospital
Wake Forest University School of Medicine
National University Hospital
Pontificia Universidad Católica de Chile
CHU de Nantes
University of Oxford
Vrije Universiteit Brussel
University of Michigan, Ann Arbor
Università degli Studi di Genova
Hôpital Henri Mondor
Centre Hospitalier Universitaire Vaudois
Shaare Zedek Medical Center
Monash University
Tata Memorial Hospital
Hopital Edouard Herriot
University of Toronto
University of the Witwatersrand, Johannesburg
Cedars-Sinai Medical Center
Universidade Federal de São Paulo
University of Maryland School of Medicine
Mahidol University
Hospital Universitari de Bellvitge
Vagelos College of Physicians and Surgeons
King's College London
Medizinische Universität Wien
Peking Union Medical College Hospital
University of Ulsan College of Medicine
Mayo Clinic
Guy's and St Thomas' NHS Foundation Trust
Royal Melbourne Hospital
Hospital Universitario de Getafe
Chelsea and Westminster Hospital
Amsterdam UMC - University of Amsterdam
Gandhi Medical College
Christian Medical College, Vellore
University of Maryland
A.O.U. Policlinico-San Marco
Regency Super Speciality Hospital
International Fluid Academy
German Center for Lung Research
Max Super Speciality Hospital
Columbia Asia Referral Hospital
PSRI Hospital
NMC Speciality Hospital
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.