An ERS Task Force committee composed of specialists in the field of respiratory infections and critical care and experts from the Chinese Thoracic Society have published a set of living guidelines on the management of hospitalised adults with coronavirus disease (COVID-19).
Published in the European Respiratory Journal, the guidelines provide evidence-based, best-practice recommendations that aim to support health professionals to reduce mortality and prevent complications, such as the need for intensive care unit admission and prolonged hospital stay.
The Task Force conducted a systematic literature review of the latest available data to develop the guidelines, which offer a review of the most notable potential therapies for treating COVID-19 and recommendations on their effectiveness and suitability.
In summary, the Task Force makes the following recommendations for the management of adults who are hospitalised with COVID-19:
- For those needing oxygen or ventilatory support, antibody treatments such as tocilizumab should be used along with the steroid dexamethasone.
- All hospitalised patients should be offered blood thinning treatments to prevent blood clots.
- In the absence of immediate indications for intubation in COVID-19 patients with hypoxaemic acute respiratory failure, health professionals should use high flow oxygen or deliver noninvasive CPAP ventilation using tight-fitting face masks or helmets.
- The committee strongly advises against the use of hydroxychloroquine to treat COVID-19 due to lack of evidence of its effectiveness and the potential harmful side-effects associated with its use.
- The committee also advises against the use of lopinavir-ritonavir, azithromycin, colchicine, and remdesivir for treating COVID-19 based on the lack of evidence for their effectiveness.
Professor Nicolas Roche, ERS Guidelines Director and guideline co-chair, commented on the new publication: “For scientific societies, as for the Society as a whole, the COVID-19 pandemic underlined how the ability to react quickly to emerging conditions is crucial. In such situations, the initial lack of evidence is followed by a rapidly progressive influx of literature, making it difficult for clinicians to identify the most optimal options.
“To help caregivers, ERS decided to produce consensus-based guidance initially, followed by evidence-based clinical practice guidelines. These were developed following a fast-track process in a six-month timeframe, despite the constant flow of new evidence on the nine specific therapeutic topics that were addressed. Thanks to the great efforts produced by the team and the ERS office, clear and up-to-date guidelines have been produced, which should be extremely useful to clinicians.”
Health professionals are encouraged to take the guidelines into account in their clinical practice.