Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU: First Update
Authors: Alhazzani Waleed , Evans Laura , Alshamsi Fayez , Møller Morten Hylander , Ostermann Marlies , Prescott Hallie C. , Arabi Yaseen M. , Loeb Mark , Ng Gong Michelle , Fan Eddy , Oczkowski Simon , Levy Mitchell M. , Derde Lennie , Dzierba Amy , Du Bin , Machado Flavia , Wunsch Hannah , Crowther Mark , Cecconi Maurizio , Koh Younsuck , Burry Lisa , Chertow Daniel S. , Szczeklik Wojciech , Belley-Cote Emilie , Greco Massimiliano , Bala Malgorzata , Zarychanski Ryan , Kesecioglu Jozef , McGeer Allison , Mermel Leonard , Mammen Manoj J. , Nainan Myatra Sheila , Arrington Amy , Kleinpell Ruth , Citerio Giuseppe , Lewis Kimberley , Bridges Elizabeth , Memish Ziad A. , Hammond Naomi , Hayden Frederick G. , Alshahrani Muhammed , Al Duhailib Zainab , Martin Greg S. , Kaplan Lewis J. , Coopersmith Craig M. , Antonelli Massimo , Rhodes Andrew 
Published: January 2021

BACKGROUND:
The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.

METHODS:
The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization’s definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

RESULTS:
The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning.

CONCLUSION:
The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.