Original Article
The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

https://doi.org/10.1016/j.jiph.2021.10.005Get rights and content
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Abstract

Background

The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU).

Methods

The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations.

Results

The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations.

Conclusion

The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.

Abbreviations

ARDS
acute respiratory distress syndrome
CI
confidence interval
CrI
credible interval
CRP
C-reactive protein
EtD
evidenced to decision
GDT
guideline development tool
GRADE
Grading of Recommendations, Assessment, Development and Evaluation
GUIDE
guidelines in intensive care, development, and evaluation
HR
hazard ratio
HCQ
hydroxychloroquine
HFNC
high flow nasal cannula
ICU
intensive care unit
IDSA
Infectious Disease Society of America
MI
myocardial infarction
NIH
National Institute of Health
NIV
noninvasive ventilation
OR
odds ratio
PE
pulmonary embolism
RCT
randomized controlled trials
RdRP
RNA-dependent RNA polymerase
RR
relative risk
SCCS
Saudi Critical Care Society
WHO
World Health Organization

Keywords

COVID-19
Therapy
Practice guideline
Intensive care unit

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