COVID-19 Clinical Guidelines–Critical Care

If we can assist your organization in the battle against COVID-19, whether or not you are a current member, please contact us today at clientservices@ecri.org.

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

Guideline Topics

  • 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 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

Intended Users
Clinicians

Guideline Topics

  • 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

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

Guideline Topics

  • 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 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

Guideline Topics

  • 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

Guideline Topics

  • 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

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

Guideline Topics

  • 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 Apr 9
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

Guideline Topics

  • 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

Guideline Topics

  • 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

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

Guideline Topics

  • 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

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

Intended Users
Health care workers

Guideline Topics

  • 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

Guideline Topics

  • 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)

Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected: interim guidance

Date: 2020 Mar 13
Developer: World Health Organization (WHO)

Guideline Focus
Management of SARI when COVID-19 disease is suspected

Patient Population
Adult, pregnant, and pediatric patients with COVID-19

Guideline Topics

  • Screening, triage, diagnosis and infection prevention measures
  • Symptomatic treatment and monitoring for mild disease
  • Oxygen therapy and treatment of co-infections in severe disease
  • Management of ARDS and septic shock, and prevention of complications in critical illness
  • Guidance on adjunctive therapy with steroids and the role of clinical research
  • Care of special populations, including pregnant women, breastfeeding mothers and infants, and older persons

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

Date: 2020 Apr 7
Developer: Fleischner Society (FS)

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

Patient Population
Patients with COVID-19

Guideline Topics

  • 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

Guideline Topics

  • 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

Return to the ECRI COVID-19 Resource Center