RAND appropriateness panel to determine the applicability of international guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic
File(s)
Accepted version
Supporting information
Author(s)
Type
Journal Article
Abstract
Background: COVID-19 has become the commonest cause of ARDS world-wide. Features of the pathophysiology and clinical presentation partially distinguish it from “classical” ARDS. A RAND analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template. Methods: An 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1-9 (where, 1-3 is inappropriate, 4-6 is uncertain and 7-9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into: investigations 16, non-invasive respiratory support 18, basic ICU management of ARDS 20, management of refractory hypoxaemia 8, pharmacotherapy 7, and anticoagulation 7, was completed again. Results: Disagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For ARDS patients with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous-thrombo-embolic disease.
Conclusion: The expert panel found no reason to deviate from the evidence based supportive strategies for managing ARDS outlined in recent guidelines.
Conclusion: The expert panel found no reason to deviate from the evidence based supportive strategies for managing ARDS outlined in recent guidelines.
Date Issued
2022-01-12
Date Acceptance
2021-04-09
Citation
Thorax, 2022, 77 (2), pp.129-135
ISSN
0040-6376
Publisher
BMJ Publishing Group
Start Page
129
End Page
135
Journal / Book Title
Thorax
Volume
77
Issue
2
Copyright Statement
© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.
Subjects
Science & Technology
Life Sciences & Biomedicine
Respiratory System
ARDS
assisted ventilation
COVID-19
critical care
non invasive ventilation
viral infection
MECHANICAL VENTILATION
CRITICAL-CARE
ARDS
COVID-19
assisted ventilation
critical care
non invasive ventilation
viral infection
COVID-19
COVID-19 Testing
Humans
Pandemics
Research
Respiration, Artificial
Respiratory Distress Syndrome
SARS-CoV-2
United Kingdom
Humans
Respiration, Artificial
Research
Pandemics
United Kingdom
Respiratory Distress Syndrome
COVID-19
SARS-CoV-2
COVID-19 Testing
Respiratory System
1103 Clinical Sciences
Publication Status
Published
Date Publish Online
2021-05-27