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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment, Quality Improvement, Diagnosis Alhazzani W, Moller MH, Arabi YM, et al. Surviving Sepsis Campaign: Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19). Crit Care Med. 2020 Jun;48(6):e440-e469. doi: 10.1097/CCM.0000000000004363.
Abstract

BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed.

METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevant to the management of COVID-19 in the ICU. We searched the literature for direct and indirect evidence on the management of COVID-19 in critically ill patients in the ICU. We identified relevant and recent systematic reviews on most questions relating to supportive care. We assessed the certainty in the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach, then generated recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility. Recommendations were either strong or weak, or in the form of best practice recommendations.

RESULTS: The Surviving Sepsis Campaign COVID-19 panel issued 54 statements, of which four are best practice statements, nine are strong recommendations, and 35 are weak recommendations. No recommendation was provided for six questions. The topics were: 1) infection control, 2) laboratory diagnosis and specimens, 3) hemodynamic support, 4) ventilatory support, and 5) COVID-19 therapy.

CONCLUSION: The Surviving Sepsis Campaign COVID-19 panel issued several recommendations to help support healthcare workers caring for critically ill ICU patients with COVID-19. When available, we will provide new evidence in further releases of these guidelines.

Ratings
Discipline / Specialty Area Score
Infectious Disease
Respirology/Pulmonology
Public Health
Hospital Doctor/Hospitalists
Internal Medicine
Intensivist/Critical Care
Comments from MORE raters

Hospital Doctor/Hospitalists rater

This information is useful and practical. I highlighted key areas for residents and other attending staff. I appreciate the organization and the actionable nature of the recommendations. Are they perfect? Probably not. Do they help? Definitely.

Hospital Doctor/Hospitalists rater

Most hospitals and hospital systems have already issued guidance that is largely concordant with these recommendations. Nonetheless, it is very useful to read the rationale behind each recommendation. I think this is critical information for all physicians that manage COVID-19 patients.

Hospital Doctor/Hospitalists rater

Timely and very useful at a time when non-specialists (in Critical Care) are being recruited into Critical Care as resource capacity is exceeded.

Infectious Disease rater

Useful and detailed recommendations while we await trial results of specific treatments for COVID-19.

Intensivist/Critical Care rater

A timely and very useful evidence-based guideline in lock-step with CDC-WHO recommended infection control practices This has excellent guidelines for managing mechanical ventilation and shock in COVID-19, appropriately recommending against unproven empiric antiviral therapy, such as lopinavir/ritonavir, and empiric tocilizumab. Unfortunately, these are being used routinely in many centers with no evidence of efficacy, but delaying urgently needed multicenter placebo-control RCTs. The Surviving Sepsis Guideline`s recommendation for adjunctive coticosteroid therapy in ARDS, however, is not consonant with the conclusions of a recent critical review citing the lack of evidence for benefit of corticosteroid therapy in severe pneumonia/ARDS from SARS and MERS. It appropriately recommends against empiric corticosteroid therapy for severe lung injury from COVID-19 (Lancet 395:473, 2020), or WHO management recommendations for COVID-19 with ARDS influenced by this review.

Intensivist/Critical Care rater

Lots of good information in this. A lot of it is good critical care and not specific to COVID, but there are some COVID-specific treatment recommendations.

Internal Medicine rater

This is all new, so very helpful to have guidelines.

Internal Medicine rater

I am glad for good guidance. I do wonder whether having so many recommendations, especially when they are weak, is more of a distraction than helpful. That is, physicians should know the basics of supportive care in viral infections, sepsis, shock, and ARDS. Limiting the number of recommendations may help improve focus and reduce performance anxiety.

Public Health rater

This is much more a clinical guideline for critical care providers/hospitalists caring for Covid-19 patients than a public health-related paper.

Public Health rater

This is an evolving topic, but the review is very helpful in outlining the strength of recommendations for care of Covid-19 patients.

Respirology/Pulmonology rater

Useful and relevant information.