COVID-19 Clinical Guidelines–Critical Care

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Advanced pulmonary and cardiac support of COVID-19 patients: emerging recommendations from ASAIO-a "living working document"

Date: 2020 Jun
Developer: ASAIO

Guideline Focus
Advanced pulmonary and cardiac support of COVID-19

Patient Population
Patients with severe COVID-19

Major Interventions

  • Clinical pathophysiology and diagnostic strategies
  • Pharmacological treatment options
  • Mechanical pulmonary and cardiac support, including extracorporeal membrane oxygenation (ECMO) considerations

APSF/ASA guidance on purposing anesthesia machines as ICU ventilators

Date: 2020 May 7
Developer: American Society of Anesthesiology (ASA)/American Patient Safety Foundation (APSF)

Guideline Focus
Purposing anesthesia machines as ICU ventilators

Patient Population
Adult patients with COVID-19 requiring mechanical ventilation

Major Interventions

  • Regulatory and manufacturer considerations
  • Involvement of anesthesia professionals in device management
  • Patient criteria for anesthesia ventilator consideration
  • Guidance on clinical location for machine use
  • Machine type, setup, settings, oxygen conservation, humidification, monitoring, maintenance and other equipment considerations
  • Guidance on use of inhaled anesthetics
  • Decontaminating machines between patients

Clinical consensus recommendations regarding non-invasive respiratory support in the adult patient with acute respiratory failure secondary to SARS-CoV-2 infection

Date: 2020 May
Developer: Spanish Society of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC)/Spanish Society of Pulmonology and Thoracic Surgery (SEPAR)/Spanish Society of Emergency Medicine (SEMES)/Spanish Society of Anesthesiology, Resuscitation and Pain Therapeutics (SEDAR)

Guideline Focus
Guidance on non-invasive respiratory support (NIRS) in patients with COVID-19 with acute respiratory failure (ARF)

Patient Population
Adult patients with suspected or confirmed presentation of COVID-19 with ARF

Major Interventions

  • Identification of patients at risk for requiring NIRS
  • Escalation of therapeutic strategies for NIRS
  • Prevention and control of infection in patients receiving NIRS
  • Interventions based on NIRS modality

Clinical management of COVID-19: interim guidance

Date: 2020 May 27
Developer: World Health Organization (WHO)

Guideline Focus
Management of COVID-19

Patient Population
Adult and pediatric patients with COVID-19

Major Interventions

  • Screening, triage, diagnosis and infection prevention measures
  • Symptomatic treatment and monitoring for mild disease
  • Treatment of pneumonia in moderate and severe disease
  • Management of ARDS and septic shock, and prevention of complications in critical illness
  • Guidance on adjunctive therapies and treatment of other infections, conditions, and manifestations
  • Care of special populations, including pregnant women, breastfeeding mothers and infants, older persons, and those requiring palliative care
  • Ethical considerations, reporting of death, and the role of clinical research

Consensus statement: Safe Airway Society principles of airway management and tracheal intubation specific to the COVID-19 adult patient group

Date: 2020 Jun
Developer: Safe Airway Society (SAS)

Guideline Focus
Airway management and tracheal intubation in adults with COVID-19

Patient Population
Adult patients with COVID-19

Major Interventions

  • Maintaining adherence to standardized intubation guidelines
  • Use of specific COVID-19 checklist and role of early intubation
  • Staffing and patient safety considerations, including intubation team members
  • Principles of airway management, including environment and equipment
  • Process of airway management, including intubation, extubation, and considerations for urgent surgery, unplanned, and prehospital care

COVID‐19: interim guidance on management pending empirical evidence

Date: 2020 Apr 3
Developer: American Thoracic Society (ATS)

Guideline Focus
Management of COVID-19

Patient Population
Patients with COVID-19

Major Interventions

  • Guidance on use of hydroxychloroquine or chloroquine based on disease severity and presence of pneumonia with attention to shared decision-making
  • Guidance on use of antiviral medications, tocilizumab, and systemic corticosteroids for hospitalized patients with pneumonia
  • Use of prone ventilation in patients with refractory hypoxemia from acute respiratory distress syndrome (ARDS)
  • Role of ECMO for patients with ARDS who have failed prone ventilation

COVID-19 position statement: maternal critical care provision. Version 1

Date: 2020 May 19
Developer: Scottish Intercollegiate Guidelines Network (SIGN)

Guideline Focus
Management of obstetric-related critical care admissions and sicker obstetric patients during COVID-19 pandemic

Patient Population
Patients who are pregnant during COVID-19 pandemic, including those who are critically ill

Major Interventions

  • Routine antenatal care and planning for delivery
  • Management considerations for patients with respiratory symptoms, including assessment algorithm
  • Criteria for referral to critical care and modifications to management
  • Educational considerations for staff caring for pregnant patients with COVID-19
  • Midwifery management during delivery
  • Anticoagulation, respiratory support, and other delivery considerations
  • Postnatal contraception and iron supplementation

COVID-19 position statement: prevention of circuit thrombosis in adult inpatients who are COVID-19 positive and undergoing renal replacement therapy (RRT) on critical care wards. Version 1

Date: 2020 May 27
Developer: Scottish Intercollegiate Guidelines Network (SIGN)

Guideline Focus
Appropriate use of anticoagulation in patients with COVID-19 who are receiving renal replacement therapy

Patient Population
Adult patients with COVID-19 undergoing renal replacement therapy

Major Interventions

  • Role of systemic infusion of unfractionated heparin
  • Use of anti-Xa measurements for monitoring
  • Development of site-specific standard operating procedures

COVID-19 rapid guideline: acute myocardial injury

Date: 2020 Apr 23
Developer: National Institute for Health and Care Excellence (NICE)

Guideline Focus
Acute myocardial injury in COVID-19

Patient Population
Patients with COVID-19 and acute myocardial injury

Major Interventions

  • Communicating with patients
  • Use of personal protective equipment (PPE) and patient isolation
  • Clinical presentation and diagnostic testing
  • Management of acute myocardial injury, including monitoring, specialty care, and critical care considerations
  • Guidance on use of medications to treat COVID-19 in patients with myocardial injury

COVID-19 rapid guideline: critical care

Date: 2020 Mar 20
Developer: National Institute for Health and Care Excellence (NICE)

Guideline Focus
Critical care management of adults with COVID-19

Patient Population
Adult patients with COVID-19

Major Interventions

  • Assessment of frailty and infection control at admission
  • Criteria for referral to critical care, treatment plans for critical patients, and cessation of critical care
  • Guidance on clinical decision-making and documentation
  • Support of clinicians who do not usually work in the critical care setting
  • Organizational level considerations and coordination of resources
  • Role of ECMO

Extracorporeal Life Support Organization coronavirus disease 2019 interim guidelines: a consensus document from an international group of interdisciplinary extracorporeal membrane oxygenation providers

Date: 2020 Jul
Developer: Extracorporeal Life Support Organization (ELSO)

Guideline Focus
Extracorporeal membrane oxygenation (ECMO) use in the COVID-19 pandemic

Patient Population
Neonatal, pediatric, and adult patients requiring ECMO during the COVID-19 pandemic

Major Interventions

  • Patient selection and timing of ECMO initiation
  • Cannulation strategies, ECMO initiation, and ongoing care
  • Transport on ECMO, weaning from ECMO, and decannulation
  • Infection control, staff safety, ethical dilemmas, quality assurance, and ongoing research

ICS guidance for prone positioning of the conscious COVID patient

Date: 2020
Developer: Intensive Care Society (ICS)

Guideline Focus
Prone positioning of the conscious COVID-19 patient

Patient Population
Patients with COVID-19 requiring respiratory support

Major Interventions

  • Benefits of prone positioning
  • Role of conscious prone positioning in hospitalized patients
  • Indications and contraindications for prone positioning
  • Flow diagram decision tool for patient selection and monitoring
  • Protocol for timed position changes

Interim guidance for basic and advanced life support in adults, children, and neonates with suspected or confirmed COVID-19: from the Emergency Cardiovascular Care Committee and Get With the Guidelines ®-Resuscitation Adult and Pediatric Task Forces of the American Heart Association in collaboration with the American Academy of Pediatrics, American Association for Respiratory Care, American College of Emergency Physicians, the Society of Critical Care Anesthesiologists, and American Society of Anesthesiologists

Date: 2020 Jun 23
Developer: American Heart Association (AHA)/American Academy of Pediatrics (AAP)/American Association for Respiratory Care (AARC)/American College of Emergency Physicians (ACEP)/Society of Critical Care Anesthesiologists (SCCA)/American Society of Anesthesiologists (ASA)

Guideline Focus
Basic and advanced life support in patients with COVID-19

Patient Population
Adult and pediatric patients with suspected or confirmed COVID-19

Major Interventions

  • Risk reduction strategies for health care workers
  • Prioritization of oxygenation and ventilation strategies with lower aerosolization rate
  • Determining appropriateness of starting and continuing resuscitation
  • Considerations for lay rescuers and EMS workers
  • Considerations for inpatients experiencing cardiac arrest, neonatal resuscitation, and management of maternal cardiac arrest
  • Algorithms for clinical scenarios for patients with COVID-19

ISTH interim guidance on recognition and management of coagulopathy in COVID-19

Date: 2020 May
Developer: International Society of Thrombosis and Haemostasis (ISTH)

Guideline Focus
Management of COVID-19 coagulopathy

Patient Population
Patients with COVID-19

Major Interventions

  • Role of universal coagulation marker measurement at admission and appropriate test selection
  • Monitoring and prognostic use of coagulation markers in hospitalized patients
  • Use of prophylactic low molecular weight heparin in hospitalized patients
  • Algorithm for management of coagulopathy in COVID-19 based on simple laboratory markers

Management of adult cardiac arrest in the COVID-19 era: consensus statement from the Australasian College for Emergency Medicine

Date: 2020 Aug
Developer: Australasian College for Emergency Medicine (ACEM)

Guideline Focus
Cardiac arrest during the COVID-19 pandemic

Patient Population
Adult patients with COVID-19

Major Interventions

  • Risk stratification and aerosol generating potential of different resuscitative measures
  • Use of personal protective equipment (PPE) and risk mitigation
  • Ethics of resuscitation and resource allocation
  • Resuscitation setting, modifications, and monitoring
  • Advanced resuscitation techniques and post-resuscitation care

Performing tracheostomy during the Covid-19 pandemic: guidance and recommendations from the Critical Care and Acute Care Surgery Committees of the American Association for the Surgery of Trauma

Date: 2020 Apr 15
Developer: American Association for the Surgery of Trauma (AAST)

Guideline Focus
Performing tracheostomy during COVID-19 pandemic

Patient Population
Patients requiring tracheostomy during COVID-19 pandemic

Major Interventions

  • Benefits of tracheostomy in the general critical care population
  • Risks to health care workers during tracheostomy
  • Guidance on indication and timing considerations for patients with COVID-19
  • Procedural modifications for high-risk surgical airways
  • Procedural preparation, safety, and risk reduction
  • Technical considerations for open and percutaneous tracheostomy

SEDAR-SEMICYUC consensus recommendations on the management of haemostasis disorders in severely ill patients with COVID-19 infection

Date: 2020 Aug-Sep
Developer: Spanish Society of Anesthesiology, Resuscitation and Pain Therapeutics (SEDAR)/Spanish Society of Intensive, Critical Care Medicine and Coronary Units (SEMICYUC)

Guideline Focus
Management of hemostasis disorders and COVID-19

Patient Population
Severely ill patients with COVID-19 and hemostasis disorders

Major Interventions

  • Role and choice of pharmacological and mechanical thromboprophylaxis
  • Dosing considerations and laboratory monitoring
  • Diagnosis of arterial and venous thrombosis
  • Treatment and monitoring of confirmed thrombotic events
  • Considerations for pregnant patients
  • Management of patients on chronic anticoagulant or anti-platelet therapies
  • Management of acute bleeding

Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19)

Date: 2020 May
Developer: Society of Critical Care Medicine (SCCM)/European Society of Intensive Care Medicine (ESICM)

Guideline Focus
Management of critically ill adults with COVID-19

Patient Population
Adult patients with COVID-19 who are critically ill

Major Interventions

  • Infection control measures for health care workers based on clinical scenario and procedure classification
  • Diagnostic testing and specimen collection
  • Fluid management and vasoactive agents
  • Respiratory support measures, including initiation, device selection, device settings, and adjuncts to respiratory management
  • Treatment options, including antiviral therapy, immunosuppressive agents, steroids, and immunomodulators

Tracheotomy recommendations during the COVID-19 pandemic

Date: 2020 Apr 2 (revised)
Developer: American Academy of Otolaryngology–Head and Neck Surgery

Guideline Focus
Tracheotomy during the COVID-19 pandemic

Patient Population
Patients with COVID-19 and respiratory failure

Major Interventions

  • Decision-making when considering tracheotomy
  • Timing of procedure and COVID-19 testing considerations
  • Intraoperative and post-procedure care
  • Risk minimization for viral spread during tracheotomy
  • Resource allocation and personal protective equipment (PPE)

The role of chest imaging in patient management during the COVID-19 pandemic: a multinational consensus statement from the Fleischner Society

Date: 2020 Jul
Developer: Fleischner Society (FS)

Guideline Focus
Role of chest imaging in management of COVID-19

Patient Population
Patients with COVID-19

Major Interventions

  • Guidance on use of chest radiography and computed tomography (CT) based on clinical features and respiratory status
  • Considerations for resource-constrained environments
  • Guidance on use of daily chest radiographs in intubated patients
  • Role of chest CT for patients with functional impairment or hypoxemia following recovery
  • Diagnostic testing for patients incidentally noted to have typical findings of COVID-19 on chest CT

Surgery in COVID-19 patients: operational directives

Date: 2020 Apr 7
Developer: National Congress of Italian Hospital Surgeons (ACOI)/Italian Society of Cardiology (SIC)/Italian Society for Trauma and Emergency Surgery (SICUT)/Italian Society of Surgical Oncology (SICO)/Italian Surgical Society for Elderly People (SICG)/Italian Society of Surgical Pathophysiology (SIFIPAC)/Italian Society of Endoscopic Surgery (SICE)/Italian Society of Anaesthesia Analgesia Resuscitation and Intensive Care (SIAARTI)

Guideline Focus
Surgery in COVID-19 patients

Patient Population
Patients requiring surgery during the COVID-19 pandemic

Major Interventions

  • Necessary personal protective equipment (PPE) and removal procedures
  • Considerations for patient transport and post-operative monitoring
  • Location, preparation, staffing, management, and sanitization of COVID operating area
  • Anesthesiology considerations
  • Waste disposal and linen management

Use of tracheostomy during the COVID-19 pandemic: American College of Chest Physicians/American Association for Bronchology and Interventional Pulmonology/Association of Interventional Pulmonology Program Directors Expert Panel report

Date: 2020 Oct
Developer: American College of Chest Physicians (CHEST)/American Association for Bronchology and Interventional Pulmonology (AABIP)/Association of Interventional Pulmonology Program (AIPPD)

Guideline Focus
Tracheostomy during the COVID-19 pandemic

Patient Population
Patients with respiratory failure from COVID-19 requiring tracheostomy

Major Interventions

  • Role of tracheostomy for patients requiring prolonged ventilation and choice of surgical approach
  • Guidance on timing of tracheostomy
  • Use of intraoperative personal protective equipment (PPE), performance in a negative-pressure room, and staffing considerations
  • Guidance on preprocedure COVID-19 testing in patients previously confirmed to be positive
  • Role of closed circuit mechanical ventilation postprocedure

Return to the ECRI COVID-19 Resource Center