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

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abstract

  • 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.

authors

  • Nasa, Prashant
  • Azoulay, Elie
  • Khanna, Ashish K
  • Jain, Ravi
  • Gupta, Sachin
  • Javeri, Yash
  • Juneja, Deven
  • Rangappa, Pradeep
  • Sundararajan, Krishnaswamy
  • Al-Hazzani, Waleed
  • Antonelli, Massimo
  • Arabi, Yaseen M
  • Bakker, Jan
  • Brochard, Laurent J
  • Deane, Adam M
  • Du, Bin
  • Einav, Sharon
  • Esteban, Andrés
  • Gajic, Ognjen
  • Galvagno, Samuel M
  • Guérin, Claude
  • Jaber, Samir
  • Khilnani, Gopi C
  • Koh, Younsuck
  • Lascarrou, Jean-Baptiste
  • Machado, Flavia R
  • Malbrain, Manu LNG
  • Mancebo, Jordi
  • McCurdy, Michael T
  • McGrath, Brendan A
  • Mehta, Sangeeta
  • Mekontso-Dessap, Armand
  • Mer, Mervyn
  • Nurok, Michael
  • Park, Pauline K
  • Pelosi, Paolo
  • Peter, John V
  • Phua, Jason
  • Pilcher, David V
  • Piquilloud, Lise
  • Schellongowski, Peter
  • Schultz, Marcus J
  • Shankar-Hari, Manu
  • Singh, Suveer
  • Sorbello, Massimiliano
  • Tiruvoipati, Ravindranath
  • Udy, Andrew A
  • Welte, Tobias
  • Myatra, Sheila N

publication date

  • December 2021