Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

Abstract

BACKGROUND: The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed. METHODS: Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences. RESULTS: A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations. CONCLUSION: There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.

Shown for reading. Its publisher allows quoting it, not republishing it.

References 151

1. 1.

   World Health Organization. Global Surveillance for human infection with coronavirus disease (COVID-19). 2020. https://www.who.int/publications-detail/global-surveillance-for-human-infection-with-novel-coronavirus-(2019-ncov).

   Not in our library

2. 2.

   World Health Organization. Coronavirus disease (COVID-2019) situation reports. 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situation-reports.

   Not in our library

3. 3.

   World Health Organization, Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. https://who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected.

   Not in our library

4. 4.

   The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19)-China. China CDC Weekly. 2020;2:113-122.

   Not in our library

5. 5.

   Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study. Lancet Respir Med. 2020.

   Not in our library10.1016/s2213-2600(20)30079-5

6. 6.

   National Health Commission & State Administration of Traditional Chinese Medicine. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial version 7.0). 2020, Mar 3. http://www.nhc.gov.cn/xcs/zhengcwj/202003/46c9294a7dfe4cef80dc7f5912eb1989/files/ce3e6945832a438eaae415350a8ce964.pdf.

   Not in our library

7. 7.

   Wax RS, Christian MD. Practical recommendations for critical care and anesthesiology teams caring for novel coronavirus (2019-nCoV) patients. Can J Anaesth. 2020.

   Not in our library10.1007/s12630-020-01591-x

8. 8.

   World Health Organization, Five moments for hand hygiene. https://www.who.int/gpsc/tools/Fivemoments/en/.

   Not in our library

9. 9.

   World Health Organization, Infection prevention and control during health care when COVID-19 is suspected. 2020 March 19, https://www.who.int/publications-detail/infection-prevention-and-control-during-health-care-when-novel-coronavirus-(ncov)-infection-is-suspected-20200125.

   Not in our library

10. 10.

    World Health Organization, Coronavirus disease (COVID-19) outbreak: rights, roles and responsibilities of health workers, including key considerations for occupational safety and health. 2020 March 19, https://www.who.int/publications-detail/coronavirus-disease-(covid-19)-outbreak-rights-roles-and-responsibilities-of-health-workers-including-keyconsiderations-for-occupational-safety-and-health.

    Not in our library

11. 11.

    Zhe Jiang University, Handbook of COVID-19 Prevention and Treatment. 2020, http://che.zju.edu.cn/cheen/2020/0401/c27758a2021088/page.htm

    Not in our library

12. 12.

    Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med. 2019.

    Not in our library10.1007/s00134-020-06022-5

13. 13.

    World Health Organization, Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19). 2020 March 19 https://apps.who.int/iris/bitstream/handle/10665/331498/WHO-2019-nCoV-IPCPPE_use-2020.2-eng.pdf.

    Not in our library

14. 14.

    Twu SJ, Chen TJ, Chen CJ, Olsen SJ, Lee LT, Fisk T, et al. Control measures for severe acute respiratory syndrome (SARS) in Taiwan. Emerg Infect Dis. 2003;9:718-720.

    Not in our library10.3201/eid0906.030283

15. 15.

    Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China. JAMA. 2019.

    Not in our library10.1001/jama.2020.1585

16. 16.
    Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review · 2012

    No notice
17. 17.

    General Office of National Health Committee. Guideline of Prevention and Control of Novel Coronavirus Infection Within Medical Facilities (first edition). 2020. http://www.nhc.gov.cn/yzygj/s7659/202001/b91fdab7c304431eb082d67847d27e14.shtml.

    Not in our library

18. 18.

    Zuo MZ, Huang YG, Ma WH, Xue ZG, Zhang JQ, Gong YH, et al. Chinese Society of Anesthesiology Task Force on Airway Management: expert recommendations for tracheal intubation in critically ill patients with novel coronavirus disease 2019. Chin Med Sci J. 2020.

    Not in our library10.24920/003724

19. 19.

    Lewis SR, Butler AR, Parker J, Cook TM, Schofield-Robinson OJ, Smith AF. Videolaryngoscopy versus direct laryngoscopy for adult patients requiring tracheal intubation: a Cochrane Systematic Review. Br J Anaesth. 2017;119:369-383.

    Not in our library10.1093/bja/aex228

20. 20.

    Centers for Disease Control and Prevention, Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control.html.

    Not in our library

21. 21.

    Xu Y, Meng M, Li L, Liu J, Chen DC. Recommendations for bronchoscopy procedures in severe COVID-19 patients. Chin J Crit Care Intensive Care Med. 2020;6:E031.

    Not in our library

22. 22.

    Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Sevestre J, et al. Clinical and microbiological effect of a combination of hydroxychloroquine and azithromycin in 80 COVID-19 patients with at least a six-day follow up: a pilot observational study. Travel Med Infect Dis. 2020;1:101663.

    Not in our library10.1016/j.tmaid.2020.101663

23. 23.
    Effect of High vs Low Doses of Chloroquine Diphosphate as Adjunctive Therapy for Patients Hospitalized With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection · 2020

    No notice
24. 24.

    Cao B, Wang Y, Wen D, Liu W, Wang J, Fan G, et al. A trial of lopinavir–ritonavir in adults hospitalized with severe Covid-19. N Engl J Med. 2020.

    Not in our library10.1056/nejmoa2001282

25. 25.

    Zhu Z, Lu Z, Xu T, Chen C, Yang G, Zha T, et al. Arbidol monotherapy is superior to lopinavir/ritonavir in treating COVID-19. J Infect. 2020.

    Not in our library10.1016/j.jinf.2020.03.060

26. 26.

    Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, et al. Compassionate use of remdesivir for patients with severe COVID-19. N Engl J Med. 2020.

    Not in our library10.1056/nehmoa2007016

27. 27.

    Wang YM, Zhang DY, Du GH, Du RH, Zhao JP, Jin Y, et al. Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. Lancet. 2020.

    Not in our library10.1016/s0140-6736(20)31022-9

28. 28.

    Grein J, Ohmagari N, Shin D, Diaz G, Asperges E, Castagna A, et al. Compassionate Use of remdesivir for patients with severe Covid-19. N Engl J Med. 2020.

    Not in our library10.1056/nejmoa2007016

29. 29.

    Gilead. Gilead Announces Approval of Veklury® (remdesivir) in Japan for Patients With Severe COVID-19, 2020. https://www.gilead.com/news-and-press/press-room/press-releases/2020/5/gilead-announces-approval-of-veklury-remdesivir-in-japan-for-patients-with-severe-covid19.

    Not in our library

30. 30.

    Casadevall A, Pirofski LA. The convalescent sera option for containing COVID-19. J Clin Invest. 2020.

    Not in our library10.1172/jci138003

31. 31.

    Luke TC, Kilbane EM, Jackson JL, Hoffman SL. Meta-analysis: convalescent blood products for Spanish influenza pneumonia: a future H5N1 treatment? Ann Intern Med. 2006;145:599-609.

    Not in our library10.7326/0003-4819-145-8-200610170-00139

32. 32.

    Cheng Y, Wong R, Soo YOY, Wong WS, Lee CK, Ng MHL, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis. 2005;24:44-46.

    Not in our library10.1007/s10096-004-1271-9

33. 33.

    Hung IF, To KK, Lee CK, Lee KL, Chan K, Yan WW, et al. Convalescent plasma treatment reduced mortality in patients with severe pandemic influenza A (H1N1) 2009 virus infection. Clin Infect Dis. 2011;52:447-456.

    Not in our library10.1093/cid/ciq106

34. 34.

    Ko JH, Seok H, Cho SY, Ha YE, Baek JY, Kim SH, et al. Challenges of convalescent plasma infusion therapy in Middle East respiratory coronavirus infection: a single centre experience. Antivir Ther. 2018;23(7):617-622.

    Not in our library10.3851/imp3243

35. 35.

    Shen C, Wang Z, Zhao F, Yang Y, Li J, Yuan J, et al. Treatment of 5 critically ill patients with COVID-19 with convalescent plasma. JAMA. 2020.

    Not in our library10.1001/jama.2020.4783

36. 36.
    Effectiveness of convalescent plasma therapy in severe COVID-19 patients · 2020

    No notice
37. 37.

    Marano G, Vaglio S, Pupella S, Facco G, Catalano L, Liumbruno GM, et al. Convalescent plasma: new evidence for an old therapeutic tool? Blood Transfus. 2016;14:152-157.

    Not in our library10.2450/2015.0131-15

38. 38.

    Delclaux C, L’Her E, Alberti C, Mancebo J, Abroug F, Conti G, et al. Treatment of acute hypoxemic nonhypercapnic respiratory insufficiency with continuous positive airway pressure delivered by a face mask: a randomized controlled trial. JAMA. 2000;284:2352-2560.

    Not in our library10.1001/jama.284.18.2352

39. 39.

    Frat JP, Thille AW, Mercat A, Girault C, Ragot S, Perbet S, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372:2185-2196.

    Not in our library10.1056/nejmoa1503326

40. 40.

    Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Non-invasive Ventilation of Patients with ARDS: insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017;195(1):67-77.

    Not in our library10.1164/rccm.201606-1306oc

Cited by papers we hold 5

• Case Report: The Experience of Managing a Moderate ARDS Caused by SARS-CoV-2 Omicron BA.2 Variant in Chongqing, China: Can We Do Better? · 2022
  Not checked
• Unraveling the Mystery Surrounding Post-Acute Sequelae of COVID-19 · 2021
  No notice
• Prognostic Accuracy of Early Warning Scores for Clinical Deterioration in Patients With COVID-19 · 2021
  Not checked
• Tracheostomy in 80 COVID-19 Patients: A Multicenter, Retrospective, Observational Study · 2020
  Not checked
• Patients with COVID-19 in 19 ICUs in Wuhan, China: a cross-sectional study · 2020
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.