Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
Prashant Nasa
(1)
,
Elie Azoulay
(2)
,
Ashish Khanna
(3)
,
Ravi Jain
(4)
,
Sachin Gupta
(5)
,
Yash Javeri
,
Deven Juneja
,
Pradeep Rangappa
,
Krishnaswamy Sundararajan
,
Waleed Alhazzani
,
Massimo Antonelli
(6)
,
Yaseen Arabi
(7)
,
Jan Bakker
(8, 9, 10)
,
Laurent Brochard
(11)
,
Adam Deane
(12)
,
Bin Du
(13)
,
Sharon Einav
(14)
,
Andrés Esteban
(15)
,
Ognjen Gajic
(16)
,
Samuel Galvagno
(17)
,
Claude Guérin
(18)
,
Samir Jaber
(19, 20)
,
Gopi Khilnani
,
Younsuck Koh
(21)
,
Jean-Baptiste Lascarrou
(22)
,
Flavia Machado
(23)
,
Manu Malbrain
(24, 25)
,
Jordi Mancebo
(26)
,
Michael Mccurdy
(17)
,
Brendan Mcgrath
(27, 28)
,
Sangeeta Mehta
(29)
,
Armand Mekontso-Dessap
(30, 31)
,
Mervyn Mer
(32)
,
Michael Nurok
(33)
,
Pauline Park
(34)
,
Paolo Pelosi
(35, 36)
,
John Peter
(37)
,
Jason Phua
(38)
,
David Pilcher
(39)
,
Lise Piquilloud
(40)
,
Peter Schellongowski
(41)
,
Marcus Schultz
(42, 43, 44)
,
Manu Shankar-Hari
(45, 46)
,
Suveer Singh
(47, 48)
,
Massimiliano Sorbello
,
Ravindranath Tiruvoipati
(39)
,
Andrew Udy
(49)
,
Tobias Welte
(50)
,
Sheila Myatra
(51)
1
NMC Specialty Hospital, Al Nahda,
2 AP-HP - Hopital Saint-Louis [AP-HP]
3 Wake Forest School of Medicine [Winston-Salem]
4 Mahatma Gandhi Hospital
5 Narayana Super Speciality Hospital
6 Fondazione Policlinico Universitario Agostino Gemelli IRCCS
7 KSAU-HS - King Saud Bin Abdulaziz University for Health Sciences [Riyadh]
8 NYU - New York University School of Medicine
9 Erasmus MC - Erasmus University Medical Center [Rotterdam]
10 UC - Pontificia Universidad Católica de Chile
11 Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto]
12 The Royal Melbourne Hospital
13 PUMCH - Peking Union Medical College Hospital [Beijing]
14 Shaare Zedek Medical Center [Jerusalem, Israel]
15 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
16 Mayo Clinic
17 University of Maryland School of Medicine
18 IMRB - Institut Mondor de Recherche Biomédicale
19 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
20 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
21 University of Ulsan
22 CHU Nantes - Centre Hospitalier Universitaire de Nantes
23 Unifesp - Federal University of Sao Paulo
24 International Fluid Academy
25 VUB - Vrije Universiteit Brussel [Bruxelles]
26 Hospital Universitari Sant Pau, Barcelona
27 MFT - Manchester University NHS Foundation Trust
28 Manchester Academic Health Sciences Centre [Manchester, UK]
29 Mount Sinai Health System
30 Hôpital Henri Mondor
31 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
32 WITS - University of the Witwatersrand [Johannesburg]
33 Cedars-Sinai Medical Center
34 University of Michigan Medical School [Ann Arbor]
35 Ospedale Policlinico San Martino [Genoa]
36 UniGe - Università degli studi di Genova = University of Genoa
37 CMCHL - Christian Medical College and Hospital Ludhiana [Punjab, India]
38 NKUA - National and Kapodistrian University of Athens
39 Monash University [Melbourne]
40 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
41 Medizinische Universität Wien = Medical University of Vienna
42 VU University Medical Center [Amsterdam]
43 Mahidol University [Bangkok]
44 University of Oxford
45 Guy's and St Thomas' Hospital [London]
46 King‘s College London
47 Royal Brompton Hospital
48 Chelsea and Westminster Hospital
49 Monash College [Melbourne]
50 German Center for Lung Research - DZL [Munich, Germany]
51 Tata Memorial Centre
2 AP-HP - Hopital Saint-Louis [AP-HP]
3 Wake Forest School of Medicine [Winston-Salem]
4 Mahatma Gandhi Hospital
5 Narayana Super Speciality Hospital
6 Fondazione Policlinico Universitario Agostino Gemelli IRCCS
7 KSAU-HS - King Saud Bin Abdulaziz University for Health Sciences [Riyadh]
8 NYU - New York University School of Medicine
9 Erasmus MC - Erasmus University Medical Center [Rotterdam]
10 UC - Pontificia Universidad Católica de Chile
11 Keenan Research Centre of the Li Ka Shing Knowledge Institute [Toronto]
12 The Royal Melbourne Hospital
13 PUMCH - Peking Union Medical College Hospital [Beijing]
14 Shaare Zedek Medical Center [Jerusalem, Israel]
15 CIBERESP - Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública = Consortium for Biomedical Research of Epidemiology and Public Health
16 Mayo Clinic
17 University of Maryland School of Medicine
18 IMRB - Institut Mondor de Recherche Biomédicale
19 PhyMedExp - Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046]
20 CHRU Montpellier - Centre Hospitalier Régional Universitaire [Montpellier]
21 University of Ulsan
22 CHU Nantes - Centre Hospitalier Universitaire de Nantes
23 Unifesp - Federal University of Sao Paulo
24 International Fluid Academy
25 VUB - Vrije Universiteit Brussel [Bruxelles]
26 Hospital Universitari Sant Pau, Barcelona
27 MFT - Manchester University NHS Foundation Trust
28 Manchester Academic Health Sciences Centre [Manchester, UK]
29 Mount Sinai Health System
30 Hôpital Henri Mondor
31 CARMAS - Groupe de recherche clinique CARMAS (Cardiovascular and Respiratory Manifestations of Acute lung injury and Sepsis)
32 WITS - University of the Witwatersrand [Johannesburg]
33 Cedars-Sinai Medical Center
34 University of Michigan Medical School [Ann Arbor]
35 Ospedale Policlinico San Martino [Genoa]
36 UniGe - Università degli studi di Genova = University of Genoa
37 CMCHL - Christian Medical College and Hospital Ludhiana [Punjab, India]
38 NKUA - National and Kapodistrian University of Athens
39 Monash University [Melbourne]
40 CHUV - Centre Hospitalier Universitaire Vaudois = Lausanne University Hospital [Lausanne]
41 Medizinische Universität Wien = Medical University of Vienna
42 VU University Medical Center [Amsterdam]
43 Mahidol University [Bangkok]
44 University of Oxford
45 Guy's and St Thomas' Hospital [London]
46 King‘s College London
47 Royal Brompton Hospital
48 Chelsea and Westminster Hospital
49 Monash College [Melbourne]
50 German Center for Lung Research - DZL [Munich, Germany]
51 Tata Memorial Centre
Elie Azoulay
- Fonction : Auteur
- PersonId : 1189025
- ORCID : 0000-0002-8162-1508
- IdRef : 066920515
Yash Javeri
- Fonction : Auteur
Deven Juneja
- Fonction : Auteur
Pradeep Rangappa
- Fonction : Auteur
Krishnaswamy Sundararajan
- Fonction : Auteur
Waleed Alhazzani
- Fonction : Auteur
Jan Bakker
- Fonction : Auteur
- PersonId : 786440
- ORCID : 0000-0003-2236-7391
Bin Du
- Fonction : Auteur
- PersonId : 783440
- ORCID : 0000-0001-6237-2895
Claude Guérin
- Fonction : Auteur
- PersonId : 756209
- ORCID : 0000-0003-4700-6672
- IdRef : 026906376
Samir Jaber
- Fonction : Auteur
- PersonId : 183664
- IdHAL : samir-jaber
- ORCID : 0000-0002-7257-8069
- IdRef : 060380829
Gopi Khilnani
- Fonction : Auteur
Jean-Baptiste Lascarrou
- Fonction : Auteur
- PersonId : 1064157
- IdHAL : jean-baptiste-lascarrou
- ORCID : 0000-0003-3706-078X
- IdRef : 150117981
Armand Mekontso-Dessap
- Fonction : Auteur
- PersonId : 1188370
- ORCID : 0000-0001-5961-5577
- IdRef : 130964603
Manu Shankar-Hari
- Fonction : Auteur
- PersonId : 798678
- ORCID : 0000-0002-5338-2538
Massimiliano Sorbello
- Fonction : Auteur
Résumé
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 (χ 2) 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
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