Article Dans Une Revue Critical Care Année : 2021

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

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 PUC - Pontificia Universidad Católica de Chile = Pontifical Catholic University of Chile [Santiago]
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 = Nantes University Hospital
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 CHU Henri Mondor [Créteil]
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 = Université de Gênes
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 MedUni Vienna - Medical University of Vienna = Medizinische Universität Wien
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 [London, United Kingdom]
48 Chelsea and Westminster Hospital
49 Monash College [Melbourne]
50 German Center for Lung Research - DZL [Munich, Germany]
51 Tata Memorial Centre
Elie Azoulay
Yash Javeri
  • Fonction : Auteur
Deven Juneja
  • Fonction : Auteur
Pradeep Rangappa
  • Fonction : Auteur
Krishnaswamy Sundararajan
  • Fonction : Auteur
Waleed Alhazzani
  • Fonction : Auteur
Ognjen Gajic
  • Fonction : Auteur
Gopi Khilnani
  • Fonction : Auteur
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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Dates et versions

hal-03173190 , version 1 (18-03-2021)

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Prashant Nasa, Elie Azoulay, Ashish Khanna, Ravi Jain, Sachin Gupta, et al.. Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method. Critical Care, 2021, 25, pp.106. ⟨10.1186/s13054-021-03491-y⟩. ⟨hal-03173190⟩
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