Management of critically ill patients with COVID-19 in ICU: statement from front-line intensive care experts in Wuhan, China

You Shang, Chun Pan, Xianghong Yang, Ming Zhong, Xiuling Shang, Zhixiong Wu, Zhui Yu, Wei Zhang, Qiang Zhong, Xia Zheng, Ling Sang, Li Jiang, Jiancheng Zhang, Wei Xiong, Jiao Liu, Dechang Chen, You Shang, Chun Pan, Xianghong Yang, Ming Zhong, Xiuling Shang, Zhixiong Wu, Zhui Yu, Wei Zhang, Qiang Zhong, Xia Zheng, Ling Sang, Li Jiang, Jiancheng Zhang, Wei Xiong, Jiao Liu, Dechang Chen

Abstract

Background: The ongoing coronavirus disease 2019 (COVID-2019) pandemic has swept all over the world, posing a great pressure on critical care resources due to large number of patients needing critical care. Statements from front-line experts in the field of intensive care are urgently needed.

Methods: Sixteen front-line experts in China fighting against the COVID-19 epidemic in Wuhan were organized to develop an expert statement after 5 rounds of expert seminars and discussions to provide trustworthy recommendation on the management of critically ill COVID-19 patients. Each expert was assigned tasks within their field of expertise to provide draft statements and rationale. Parts of the expert statement are based on epidemiological and clinical evidence, without available scientific evidences.

Results: A comprehensive document with 46 statements are presented, including protection of medical personnel, etiological treatment, diagnosis and treatment of tissue and organ functional impairment, psychological interventions, immunity therapy, nutritional support, and transportation of critically ill COVID-19 patients. Among them, 5 recommendations were strong (Grade 1), 21 were weak (Grade 2), and 20 were experts' opinions. A strong agreement from voting participants was obtained for all recommendations.

Conclusion: There are still no targeted therapies for COVID-19 patients. Dynamic monitoring and supportive treatment for the restoration of tissue vascularization and organ function are particularly important.

Keywords: COVID-19; Critical care; Expert statement.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Protocol of respiratory therapy for COVID-19-induced ARDS. NIV non-invasive ventilation, HFNC high-flow nasal cannula, PBW predict body weight, ECMO extracorporeal membrane oxygenation

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