scholarly journals Management of hospitalised adults with coronavirus disease-19 (COVID-19): A European Respiratory Society living guideline

2021 ◽  
pp. 2100048
Author(s):  
James D. Chalmers ◽  
Megan L. Crichton ◽  
Pieter C. Goeminne ◽  
Bin Cao ◽  
Marc Humbert ◽  
...  
Keyword(s):  
Task Force ◽  
Guideline Development ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Supplemental Oxygen ◽  
European Respiratory Society ◽  
Antibody Treatment ◽  
Hospitalised Patients

IntroductionHospitalised patients with coronavirus disease 19 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require non-invasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes.MethodsA task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this “living guideline” using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations.ResultsBased on the available evidence at the time of guideline development (February 20th, 2021) the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for IL-6 receptor antagonist monoclonal antibody treatment and high flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine and azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made.ConclusionThe evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.

scholarly journals Biomarkers and outcomes of COVID-19 hospitalisations: systematic review and meta-analysis

2020 ◽  
pp. bmjebm-2020-111536
Author(s):  
Preeti Malik ◽  
Urvish Patel ◽  
Deep Mehta ◽  
Nidhi Patel ◽  
Raveena Kelkar ◽  
...  
Keyword(s):  
Systematic Review ◽  
Observational Studies ◽  
Clinical Decision Making ◽  
Meta Analysis ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Mesh Terms ◽  
Hospitalised Patients ◽  
Poor Outcomes ◽  
D Dimer

ObjectiveTo evaluate association between biomarkers and outcomes in COVID-19 hospitalised patients. COVID-19 pandemic has been a challenge. Biomarkers have always played an important role in clinical decision making in various infectious diseases. It is crucial to assess the role of biomarkers in evaluating severity of disease and appropriate allocation of resources.Design and settingSystematic review and meta-analysis. English full text observational studies describing the laboratory findings and outcomes of COVID-19 hospitalised patients were identified searching PubMed, Web of Science, Scopus, medRxiv using Medical Subject Headings (MeSH) terms COVID-19 OR coronavirus OR SARS-CoV-2 OR 2019-nCoV from 1 December 2019 to 15 August 2020 following Meta-analyses Of Observational Studies in Epidemiology (MOOSE) guidelines.ParticipantsStudies having biomarkers, including lymphocyte, platelets, D-dimer, lactate dehydrogenase (LDH), C reactive protein (CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, procalcitonin (PCT) and creatine kinase (CK), and describing outcomes were selected with the consensus of three independent reviewers.Main outcome measuresComposite poor outcomes include intensive care unit admission, oxygen saturation <90%, invasive mechanical ventilation utilisation, severe disease, in-hospital admission and mortality. The OR and 95% CI were obtained and forest plots were created using random-effects models. Publication bias and heterogeneity were assessed by sensitivity analysis.Results32 studies with 10 491 confirmed COVID-19 patients were included. We found that lymphopenia (pooled-OR: 3.33 (95% CI: 2.51–4.41); p<0.00001), thrombocytopenia (2.36 (1.64–3.40); p<0.00001), elevated D-dimer (3.39 (2.66–4.33); p<0.00001), elevated CRP (4.37 (3.37–5.68); p<0.00001), elevated PCT (6.33 (4.24–9.45); p<0.00001), elevated CK (2.42 (1.35–4.32); p=0.003), elevated AST (2.75 (2.30–3.29); p<0.00001), elevated ALT (1.71 (1.32–2.20); p<0.00001), elevated creatinine (2.84 (1.80–4.46); p<0.00001) and LDH (5.48 (3.89–7.71); p<0.00001) were independently associated with higher risk of poor outcomes.ConclusionOur study found a significant association between lymphopenia, thrombocytopenia and elevated levels of CRP, PCT, LDH, D-dimer and COVID-19 severity. The results have the potential to be used as an early biomarker to improve the management of COVID-19 patients, by identification of high-risk patients and appropriate allocation of healthcare resources in the pandemic.

scholarly journals Management of COPD exacerbations: a European Respiratory Society/American Thoracic Society guideline

2017 ◽  
Vol 49 (3) ◽  
pp. 1600791 ◽  
Author(s):  
Jadwiga A. Wedzicha ◽  
Marc Miravitlles ◽  
John R. Hurst ◽  
Peter M.A. Calverley ◽  
Richard K. Albert ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Antibiotic Therapy ◽  
Pulmonary Rehabilitation ◽  
Task Force ◽  
Chronic Obstructive ◽  
Noninvasive Mechanical Ventilation ◽  
European Respiratory Society ◽  
Copd Exacerbations ◽  
Home Based ◽  
Hospitalised Patients

This document provides clinical recommendations for treatment of chronic obstructive pulmonary disease (COPD) exacerbations.Comprehensive evidence syntheses, including meta-analyses, were performed to summarise all available evidence relevant to the Task Force's questions. The evidence was appraised using the Grading of Recommendations, Assessment, Development and Evaluation approach and the results were summarised in evidence profiles. The evidence syntheses were discussed and recommendations formulated by a multidisciplinary Task Force of COPD experts.After considering the balance of desirable and undesirable consequences, quality of evidence, feasibility, and acceptability of various interventions, the Task Force made: 1) a strong recommendation for noninvasive mechanical ventilation of patients with acute or acute-on-chronic respiratory failure; 2) conditional recommendations for oral corticosteroids in outpatients, oral rather than intravenous corticosteroids in hospitalised patients, antibiotic therapy, home-based management, and the initiation of pulmonary rehabilitation within 3 weeks after hospital discharge; and 3) a conditional recommendation against the initiation of pulmonary rehabilitation during hospitalisation.The Task Force provided recommendations related to corticosteroid therapy, antibiotic therapy, noninvasive mechanical ventilation, home-based management, and early pulmonary rehabilitation in patients having a COPD exacerbation. These recommendations should be reconsidered as new evidence becomes available.

scholarly journals Efficacy and safety of colchicine in COVID-19: a meta-analysis of randomised controlled trials

RMD Open ◽  
2021 ◽  
Vol 7 (3) ◽  
pp. e001746
Author(s):  
Kedar Gautambhai Mehta ◽  
Tejas Patel ◽  
Paragkumar D Chavda ◽  
Parvati Patel
Keyword(s):  
Adverse Events ◽  
Supportive Care ◽  
Meta Analysis ◽  
Ventilatory Support ◽  
Length Of Hospital Stay ◽  
Efficacy And Safety ◽  
Serious Adverse Events ◽  
Quality Of Evidence ◽  
Randomised Controlled

BackgroundColchicine, an anti-inflammatory drug is prescribed nowadays for COVID-19. In this meta-analysis, we evaluated efficacy and safety of colchicine in patients with COVID-19.MethodsWe searched databases for randomised controlled studies evaluating efficacy and/or safety of colchicine as compared with supportive care in patients with COVID-19. The efficacy outcomes were mortality, ventilatory support, intensive care unit (ICU) admission and length of hospital stay. The safety outcomes were adverse events, serious adverse events and diarrhoea. A meta-analytical summary was estimated using random effects model through Mantle-Hanzle method. An I2 test was used to assess heterogeneity. The Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to assess quality of evidence for each outcome.ResultsOut of 69 full texts assessed, 6 studies (16148 patients with COVID-19) were included in meta-analysis. Patients receiving colchicine did not show significant reduction in mortality (risk difference, RD −0.00 (95% CI −0.01 to 0.01), I2=15%), ventilatory support (risk ratio, RR 0.67 (95% CI 0.38 to 1.21), I2=47%), ICU admission (RR 0.49 (95% CI 0.19 to 1.25), I2=34%), length of hospital stay (mean difference: −1.17 (95% CI −3.02 to 0.67), I2=77%) and serious adverse events (RD −0.01 (95% CI −0.02 to 0.00), I2=28%) than those who received supportive care only. Patients receiving colchicine had higher rates of adverse events (RR 1.58 (95% CI 1.07 to 2.33), I2=81%) and diarrhoea (RR 1.93 (95% CI 1.62 to 2.29), I2=0%) than supportive care treated patients. The GRADE quality of evidence was moderate for most outcomes.ConclusionThe moderate quality evidence suggests no benefit of addition of colchicine to the standard care regimen in patients with COVID-19.

scholarly journals Neurally adjusted ventilatory assist as a weaning mode for adults with invasive mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽  
2021 ◽  
Vol 25 (1) ◽  
Author(s):  
Xueyan Yuan ◽  
Xinxing Lu ◽  
Yali Chao ◽  
Jennifer Beck ◽  
Christer Sinderby ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Clinical Practice ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Cochrane Library ◽  
Neurally Adjusted Ventilatory Assist ◽  
Partial Support ◽  
Ventilatory Assist

Abstract Background Prolonged ventilatory support is associated with poor clinical outcomes. Partial support modes, especially pressure support ventilation, are frequently used in clinical practice but are associated with patient–ventilation asynchrony and deliver fixed levels of assist. Neurally adjusted ventilatory assist (NAVA), a mode of partial ventilatory assist that reduces patient–ventilator asynchrony, may be an alternative for weaning. However, the effects of NAVA on weaning outcomes in clinical practice are unclear. Methods We searched PubMed, Embase, Medline, and Cochrane Library from 2007 to December 2020. Randomized controlled trials and crossover trials that compared NAVA and other modes were identified in this study. The primary outcome was weaning success which was defined as the absence of ventilatory support for more than 48 h. Summary estimates of effect using odds ratio (OR) for dichotomous outcomes and mean difference (MD) for continuous outcomes with accompanying 95% confidence interval (CI) were expressed. Results Seven studies (n = 693 patients) were included. Regarding the primary outcome, patients weaned with NAVA had a higher success rate compared with other partial support modes (OR = 1.93; 95% CI 1.12 to 3.32; P = 0.02). For the secondary outcomes, NAVA may reduce duration of mechanical ventilation (MD = − 2.63; 95% CI − 4.22 to − 1.03; P = 0.001) and hospital mortality (OR = 0.58; 95% CI 0.40 to 0.84; P = 0.004) and prolongs ventilator-free days (MD = 3.48; 95% CI 0.97 to 6.00; P = 0.007) when compared with other modes. Conclusions Our study suggests that the NAVA mode may improve the rate of weaning success compared with other partial support modes for difficult to wean patients.

Standardization of spirometry: what’s new in 2019 update (Part 2)

2020 ◽  
Vol 1 (14) ◽  
pp. 10-18
Author(s):  
L. D. Kiryukhina ◽  
P. V. Struchkov
Keyword(s):  
Task Force ◽  
Test Session ◽  
American Thoracic Society ◽  
European Respiratory Society ◽  
Technical Standards ◽  
Joint Task ◽  
Joint Task Force ◽  
International Joint ◽  
New Research

Improvements in equipment, new research studies and enhanced quality assurance approaches have led to the need to update the 2005 technical standards for spirometry. The article presents the main updates, developed by an international joint task force by the American Thoracic Society and the European Respiratory Society in 2019. The characteristics of acceptability, usability, and repeatability, criteria grading the quality of the test session, the choice of main reported values are described.

Health state utility values in schizophrenia: protocol for a systematic review and meta-analysis

2019 ◽  
Vol 22 (4) ◽  
pp. 142-144 ◽  
Author(s):  
David Aceituno ◽  
Mark Pennington ◽  
Barbara Iruretagoyena ◽  
Matthew A Prina ◽  
Paul McCrone
Keyword(s):  
Systematic Review ◽  
Task Force ◽  
Meta Analysis ◽  
Cost Effective ◽  
Health State Utility ◽  
Health State ◽  
Utility Values ◽  
Life Years ◽  
Health State Utility Values

IntroductionCost-effectiveness analyses that use quality-adjusted life-years (QALYs) allow comparing the value for money of interventions across different health problems. Health state utility values (HSUVs) are crucial to calculate QALYs. These are weights attached to a given health state reflecting preferences in health-related quality of life (HRQoL). In schizophrenia, there is extensive evidence about the consequences of this condition on HRQoL. Besides, several interventions have claimed to be cost-effective in terms of QALYs gained. Despite this evidence, a systematic review of HSUVs has not been conducted. Therefore, we aim to synthesise the evidence about HSUVs in schizophrenia.Methods and analysisWe will conduct a systematic review of the literature about HSUVs in people with schizophrenia following the Preferred Reporting Items for Systematic review and Meta-Analysis and the International Society for Pharmacoeconomics and Outcomes Research task force recommendations. The submissions records of eight electronic peer-reviewed databases and three health technology assessment (HTA) agencies will be searched. Quantitative synthesis will be carried out in comparable studies, using random-effects meta-analysis. Heterogeneity will be explored using meta-regression if more than 10 studies per covariate are found. A narrative synthesis and methodological quality of included studies will be also reported.DiscussionThis review will provide a synthesis of the HSUVs estimated for different states experienced by people with schizophrenia. This will inform analysts when calculating QALYs, using values in a more transparent and accountable manner. Finally, it will shed light on evidence gaps and limitations about this measure in mental health.PROSPERO registration numberCRD42019123582.

scholarly journals European Respiratory Society guideline on long-term management of children with bronchopulmonary dysplasia

2019 ◽  
Vol 55 (1) ◽  
pp. 1900788 ◽  
Author(s):  
Liesbeth Duijts ◽  
Evelien R. van Meel ◽  
Laura Moschino ◽  
Eugenio Baraldi ◽  
Magda Barnhoorn ◽  
...  
Keyword(s):  
Lung Function ◽  
Bronchopulmonary Dysplasia ◽  
Neonatal Period ◽  
Task Force ◽  
Clinical Care ◽  
Supplemental Oxygen ◽  
Target Range ◽  
European Respiratory Society ◽  
Assessment Development ◽  
Systemic Corticosteroids

This document provides recommendations for monitoring and treatment of children in whom bronchopulmonary dysplasia (BPD) has been established and who have been discharged from the hospital, or who were >36 weeks of postmenstrual age. The guideline was based on predefined Population, Intervention, Comparison and Outcomes (PICO) questions relevant for clinical care, a systematic review of the literature and assessment of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. After considering the balance of desirable (benefits) and undesirable (burden, adverse effects) consequences of the intervention, the certainty of the evidence, and values, the task force made conditional recommendations for monitoring and treatment of BPD based on very low to low quality of evidence. We suggest monitoring with lung imaging using ionising radiation in a subgroup only, for example severe BPD or recurrent hospitalisations, and monitoring with lung function in all children. We suggest to give individual advice to parents regarding daycare attendance. With regards to treatment, we suggest the use of bronchodilators in a subgroup only, for example asthma-like symptoms, or reversibility in lung function; no treatment with inhaled or systemic corticosteroids; natural weaning of diuretics by the relative decrease in dose with increasing weight gain if diuretics are started in the neonatal period; and treatment with supplemental oxygen with a saturation target range of 90–95%. A multidisciplinary approach for children with established severe BPD after the neonatal period into adulthood is preferable. These recommendations should be considered until new and urgently needed evidence becomes available.

scholarly journals Janus Kinase Inhibitors and Coronavirus Disease (COVID)-19: Rationale, Clinical Evidence and Safety Issues

2021 ◽  
Vol 14 (8) ◽  
pp. 738
Author(s):  
Milo Gatti ◽  
Eleonora Turrini ◽  
Emanuel Raschi ◽  
Piero Sestili ◽  
Carmela Fimognari
Keyword(s):  
Clinical Evidence ◽  
Kinase Inhibitors ◽  
Invasive Mechanical Ventilation ◽  
Supplemental Oxygen ◽  
Janus Kinase ◽  
European Medicines Agency ◽  
Jak Inhibitors ◽  
Open Label ◽  
Safety Issues ◽  
Hospitalised Patients

We are witnessing a paradigm shift in drug development and clinical practice to fight the novel coronavirus disease (COVID-19), and a number of clinical trials have been or are being testing various pharmacological approaches to counteract viral load and its complications such as cytokine storm. However, data on the effectiveness of antiviral and immune therapies are still inconclusive and inconsistent. As compared to other candidate drugs to treat COVID-19, Janus Kinase (JAK) inhibitors, including baricitinib and ruxolitinib, possess key pharmacological features for a potentially successful repurposing: convenient oral administration, favorable pharmacokinetic profile, multifunctional pharmacodynamics by exerting dual anti-inflammatory and anti-viral effects. Baricitinib, originally approved for rheumatoid arthritis, received Emergency Use Authorization in November 2020 by the Food and Drug Administration in combination with remdesivir for the treatment of COVID-19 in hospitalized patients ≥ 2 years old who require supplemental oxygen, invasive mechanical ventilation, or extracorporeal membrane oxygenation. By July 2021, the European Medicines Agency is also expected to issue the opinion on whether or not to extend its use in hospitalised patients from 10 years of age who require supplemental oxygen. Ruxolitinib, approved for myelofibrosis, was prescribed in patients with COVID-19 within an open-label Emergency Expanded Access Plan. This review will address key milestones in the discovery and use of JAK inhibitors in COVID-19, from artificial intelligence to current clinical evidence, including real world experience, and critically appraise emerging safety issues, namely infections, thrombosis, and liver injury. An outlook to ongoing studies (clinicaltrials.gov) and unpublished pharmacovigilance data is also offered.

scholarly journals Home Ventilation in Children

2015 ◽  
Vol 35 (1) ◽  
pp. 85-88
Author(s):  
D Gupta ◽  
A Sachdev ◽  
N Gupta ◽  
AK Simalti
Keyword(s):  
Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Ventilatory Support ◽  
Non Invasive ◽  
Home Ventilation ◽  
Care Givers ◽  
Complete Health ◽  
Median Period ◽  
Clinical Conditions

Introduction: Home mechanical ventilation (HMV) can prolong survival and improve quality of life. The objectives were to review the challenges, clinical conditions and outcome of children who were discharged from the hospital on respiratory support.Material and Methods: Twenty four patients, who were electively discharged from PICU and had received home ventilatory support for more than 15 days, were enrolled over 11 year study period. Patients were followed up monthly, for two years, for ventilatory requirements, any problems encountered during previous month and for any complication.Results: Twenty four patients with a median age of 3.5 years were discharged home with ventilatory support. HMV was started in 2001 at our hospital. Patents received home ventilation for a median period 5.4 months. Twenty (83.3%) patients received invasive mechanical ventilation via tracheostomy and four (16.7%) patients received non-invasive mechanical ventilation. Twelve (50%) patients received ventilatory support for more than 20 hrs a day and twelve (50%) patients received only during sleep. On follow up for two years for each patient, twenty (83.3%) patients successfully came off from ventilatory support while, two (8.3%) patients died and two (8.3%) lost to follow-up.Conclusion: HMV can be safely applied in selected children with CRF after providing adequate training to the care givers. For its more efficient use, we need to have good social support and medical assistance which can be extended to their homes to meet their complete health care needs.J Nepal Paediatr Soc 2015;35(1):85-88

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