دورية أكاديمية
Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method
| العنوان: | Expert consensus statements for the management of COVID-19-related acute respiratory failure using a Delphi method |
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| المؤلفون: | Nasa, Prashant, Azoulay, Elie, Khanna, Ashish K., Jain, Ravi, Gupta, Sachin, Javeri, Yash, Juneja, Deven, Rangappa, Pradeep, Sundararajan, Krishnaswamy, Bakker, Jan |
| سنة النشر: | 2021 |
| المجموعة: | Pontificia Universidad Católica de Chile: Repositorio UC |
| مصطلحات موضوعية: | Respiratory distress syndrome adult, COVID-19 ventilatory management, COVID-19 respiratory management, COVID-19 acute respiratory distress syndrome, COVID-19 high fow nasal oxygen, COVID 19 invasive mechanical ventilation, 616.2414, Medicina y salud |
| الوصف: | 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 ... |
| نوع الوثيقة: | article in journal/newspaper |
| وصف الملف: | 17 páginas; application/pdf |
| اللغة: | English |
| العلاقة: | Critical Care. 2021 Mar 16;25(1):106; https://doi.org/10.1186/s13054-021-03491-yTest; https://repositorio.uc.cl/handle/11534/52757Test |
| DOI: | 10.1186/s13054-021-03491-y |
| الإتاحة: | https://doi.org/10.1186/s13054-021-03491-yTest https://repositorio.uc.cl/handle/11534/52757Test |
| حقوق: | acceso abierto ; The Author(s) |
| رقم الانضمام: | edsbas.4B5F33AE |
| قاعدة البيانات: | BASE |
| DOI: | 10.1186/s13054-021-03491-y |
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