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. 2020 Aug 5;24(1):486.
doi: 10.1186/s13054-020-03194-w.

International variation in the management of severe COVID-19 patients

Elie Azoulay  1 , Jan de Waele  2 , Ricard Ferrer  3   4 , Thomas Staudinger  5 , Marta Borkowska  2 , Pedro Povoa  6 , Katerina Iliopoulou  7 , Antonio Artigas  8 , Stefan J Schaller  9 , Manu Shankar-Hari  10 , Mariangela Pellegrini  11   12   13 , Michael Darmon  14 , Jozef Kesecioglu  15 , Maurizio Cecconi  16
Affiliations

International variation in the management of severe COVID-19 patients

Elie Azoulay et al. Crit Care. .

Abstract

Background: There is little evidence to support the management of severe COVID-19 patients.

Methods: To document this variation in practices, we performed an online survey (April 30-May 25, 2020) on behalf of the European Society of Intensive Care Medicine (ESICM). A case vignette was sent to ESICM members. Questions investigated practices for a previously healthy 39-year-old patient presenting with severe hypoxemia from COVID-19 infection.

Results: A total of 1132 ICU specialists (response rate 20%) from 85 countries (12 regions) responded to the survey. The survey provides information on the heterogeneity in patient's management, more particularly regarding the timing of ICU admission, the first line oxygenation strategy, optimization of management, and ventilatory settings in case of refractory hypoxemia. Practices related to antibacterial, antiviral, and anti-inflammatory therapies are also investigated.

Conclusions: There are important practice variations in the management of severe COVID-19 patients, including differences at regional and individual levels. Large outcome studies based on multinational registries are warranted.

Keywords: Acute respiratory distress syndrome; Coronavirus; Remdesivir; Viral infection.

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Conflict of interest statement

The authors declare no conflict of interest in relation to this survey.

Figures

Fig. 1
Fig. 1
World map displaying practice variations across regions regarding direct admission to the ICU or the intermediate care unit
Fig. 2
Fig. 2
World map displaying practice variations across regions regarding the use of noninvasive oxygenation strategies
Fig. 3
Fig. 3
World map displaying practice variations across regions regarding the use of neuromuscular blockades and prone positioning
Fig. 4
Fig. 4
World map displaying practice variations across regions regarding the use of antiviral agents
See this image and copyright information in PMC

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