COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Chalmers JD, Crichton ML, Goeminne PC, et al. Management of hospitalised adults with coronavirus disease 2019 (COVID-19): a European Respiratory Society living guideline. Eur Respir J. 2021 Apr 15;57(4). pii: 13993003.00048-2021. doi: 10.1183/13993003.00048-2021. Print 2021 Apr.
Abstract

INTRODUCTION: Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require noninvasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes.

METHODS: A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this "living guideline" using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations.

RESULTS: Based on the available evidence at the time of guideline development (20 February, 2021), the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for interleukin (IL)-6 receptor antagonist monoclonal antibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made.

CONCLUSION: The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.

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

Emergency Medicine rater

Excellent summary of recommendations for treating Covid.

Emergency Medicine rater

A nice systematic review (via European Guidelines) on treatment options for COVID-19. They answer questions regarding specific therapies and the evolving literature behind their decision. Since this is a living document, changes are likely to occur in the near future.

Infectious Disease rater

It is good timing to see an evidence-graded living guideline for hospitalized patients with COVID-19. Assembling the last year's best evidence for informed care of current surges and future cases reduces the stress of the last year's sometimes scattered and contradicting information.

Intensivist/Critical Care rater

This paper is internally contradictory claiming strong evidence where the quality of the evidence is moderate to poor. I would not recommend this paper as helpful to my colleagues.

Intensivist/Critical Care rater

Well done and trustworthy guideline; however, no new information so of questionable newsworthiness. Lots of other living COVID guidelines already published.

Internal Medicine rater

These recommendations change regularly good "living" assessment of where we are.

Respirology/Pulmonology rater

Up-to-date guidelines from the ERS regarding the treatment of COVID infection in hospitalized patients. Very well written and timely.