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Management of Critically Ill Adults With COVID-19

Educational Objective
To understand the latest concepts about critical care of COVID-19 patients
1 Credit CME

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of COVID-19, a pandemic that has affected more than 400 000 individuals and caused nearly 20 000 deaths as of late March 2020. Approximately 5% to 10% of patients require intensive care unit (ICU) admission and mechanical ventilation.1

The Surviving Sepsis Campaign (SSC) has previously published a series of guidelines for sepsis and septic shock. Based on this experience, experts were recruited to write guidelines on the management of COVID-19 in critically ill adults. These guidelines were authored by 36 experts from 12 countries (Table).2 Recommendations were developed based on limited direct evidence with COVID-19 cases and indirect evidence derived from previous pandemics such as Middle East respiratory syndrome (MERS), severe acute respiratory syndrome (SARS), and other coronavirus infections. Overall, the panel issued 54 statements: 4 best practice statements, 9 strong recommendations, and 35 weak recommendations. (No recommendations were made for the remaining 6 topics.)

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Article Information

Corresponding Author: Jason T. Poston, MD, University of Chicago, 850 E 58th St, Chicago, IL 60615 (Jason.Poston@uchospitals.edu).

Published Online: March 26, 2020. doi:10.1001/jama.2020.4914

Correction: This article was corrected on April 3, 2020, to include all of the related resources and relevant publications.

Conflict of Interest Disclosures: Dr Patel reports receiving grants from Parker B. Francis Career Development award and from NIH/NHLBI T32 HL007605 Research Training in Respiratory Biology. Dr Poston receiving honoraria for the CHEST Critical Care Board Review Course. Dr Davis reported no disclosures.

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Surviving Sepsis Campaign. COVID-19 Guidelines. Published March 20, 2020. https://www.sccm.org/SurvivingSepsisCampaign/Guidelines/COVID-19
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Patel  BK , Wolfe  KS , Pohlman  AS , Hall  JB , Kress  JP .  Effect of noninvasive ventilation delivered by helmet vs face mask on the rate of endotracheal intubation in patients with acute respiratory distress syndrome: a randomized clinical trial.   JAMA. 2016;315(22):2435-2441. doi:10.1001/jama.2016.6338PubMedGoogle ScholarCrossref
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SIAARTI. Clinical ethics recommendations for the allocation of intensive care treatments in exceptional resource-limited circumstances. Published March 16, 2020. Accessed March 23, 2020. http://www.siaarti.it/SiteAssets/News/COVID19%20-%20documenti%20SIAARTI/SIAARTI%20-%20Covid-19%20-%20Clinical%20Ethics%20Reccomendations.pdf
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