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Toward Universal Deployable Guidelines for the Care of Patients With COVID-19

Educational Objective
To understand the circumstances of how the new COVID-19 critical case guidelines were developed
1 Credit CME

Guidelines are developed for various reasons, including the emergence of new, potentially practice-changing evidence or a perceived need for guidance in times of uncertainty. The COVID-19 pandemic presents an almost unparalleled example of the latter, prompting the Surviving Sepsis Campaign (SSC) Task Force to rapidly produce Guidelines on the Management of Critically Ill Adults With Coronavirus Disease 2019 (COVID-19).1 These guidelines are adapted from the well-known 2016 SSC guidelines,2 and highlights are excerpted in this issue of JAMA.3 In a brief amount of time, the authors have produced an impressively thorough and expansive set of guidelines, organized as more than 50 recommendations under 4 domains. The intended goal is to reduce unwanted practice variation and provide a focused and informed distillation of the existing evidence in a manner that will be practical for, and accessible to, clinicians in a wide variety of settings around the world. Because COVID-19 is a new disease, the SSC Task Force relied on the expert interpretation of available evidence from analogous conditions, such as sepsis, when generating its recommendation. The intent of the guideline committee is to update the guidelines as evidence specific to the care of patients with COVID-19 emerges.

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Article Information

Corresponding Author: Derek C. Angus, MD, MPH, University of Pittsburgh, 3550 Terrace St, 614 Scaife Hall, Pittsburgh, PA 15261 (angusdc@upmc.edu).

Published Online: March 26, 2020. doi:10.1001/jama.2020.5110

Conflict of Interest Disclosures: Dr Lamontagne reported receiving grants from the National Institute for Health Research (NIHR), Fonds de recherche du Québec-Santé, and the Lotte & John Hecht Foundation, unrelated to this work. Dr Angus participated in the development of Surviving Sepsis Campaign guidelines for sepsis, but had no role in the creation of the current COVID-19 guidelines, nor the decision to create these guidelines.

References
1.
Surviving Sepsis Campaign. COVID-19 Guidelines. Published March 20, 2020. https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19.
2.
Rhodes  A , Evans  LE , Alhazzani  W ,  et al.  Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016.   Intensive Care Med. 2017;43(3):304-377. doi:10.1007/s00134-017-4683-6PubMedGoogle ScholarCrossref
3.
Poston  JT , Patel  BK , Davis  AM .  Management of critically ill adults with COVID-19.   JAMA. Published online March 26, 2020. doi:10.1001/jama.2020.4914Google Scholar
4.
Adhikari  NK , Dellinger  RP , Lundin  S ,  et al.  Inhaled nitric oxide does not reduce mortality in patients with acute respiratory distress syndrome regardless of severity: systematic review and meta-analysis.   Crit Care Med. 2014;42(2):404-412. doi:10.1097/CCM.0b013e3182a27909PubMedGoogle ScholarCrossref
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Leung  CCH , Joynt  GM , Gomersall  CD ,  et al.  Comparison of high-flow nasal cannula versus oxygen face mask for environmental bacterial contamination in critically ill pneumonia patients: a randomized controlled crossover trial.   J Hosp Infect. 2019;101(1):84-87. doi:10.1016/j.jhin.2018.10.007PubMedGoogle ScholarCrossref
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Lamontagne  F , Clément  C , Fletcher  T , Jacob  ST , Fischer  WA  II , Fowler  RA .  Doing today’s work superbly well—treating Ebola with current tools.   N Engl J Med. 2014;371(17):1565-1566. doi:10.1056/NEJMp1411310PubMedGoogle ScholarCrossref
7.
Brouwers  MC , Kho  ME , Browman  GP ,  et al; AGREE Next Steps Consortium.  AGREE II: advancing guideline development, reporting and evaluation in health care.   CMAJ. 2010;182(18):E839-E842. doi:10.1503/cmaj.090449PubMedGoogle ScholarCrossref
8.
Rudd  KE , Johnson  SC , Agesa  KM ,  et al.  Global, regional, and national sepsis incidence and mortality, 1990-2017: analysis for the Global Burden of Disease Study.   Lancet. 2020;395(10219):200-211. doi:10.1016/S0140-6736(19)32989-7PubMedGoogle ScholarCrossref
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