The Saudi Critical Care Society practice guidelines on the management of COVID-19 in the ICU: Therapy section

• Authors: Ziad Memish, Emory University; Malak AlThgafi, Emory University; Waleed Alhazzani, McMaster University; Mohammed Alshahrani, Imam Abdulrahman Bin Faisal University; Fayez Alshamsi, United Arab Emirates University; Ohoud Aljuhani, King Abdulaziz University; Khalid Eljaaly, King Abdulaziz University; Samaher Hashim, University of Tabuk; Rakan Alqahtani, King Saud University; Doaa Alsaleh, Icahn’s School of Medicine at Mount Sinai; Zainab Al Duhailib, King Faisal Specialist Hospital and Research Center,; Haifa Algethamy, King Abdulaziz University; Tariq Al-Musawi, Dr Sulaiman AlHabib Hospital; Thamir Alshammari, King Saud University; Abdullah Alqarni, Ministry of Health; Danya Khoujah, University of Maryland School of Medicin; Wail Tashkandi, King Abdulaziz University; Talal Dahhan, King Faisal Specialist Hospital and Research Center; Najla Almutairi, Ministry of Health, Riyadh, Saudi Arabia; Haleema A Alserehi, Saudi Publ Hlth Author; Maytha Al-Yahya, Ministry of National Guard Health Affairs, Riyadh; Bandar Al-Judaibi, University of Rochester; Yaseen M Arabi, King Abdullah International Medical Research Centre, Riyadh; Jameel Abualenain, King Abdulaziz University; Jawaher M Alotaibi, King Faisal Specialist Hospital and Research Center Riyadh, Saudi Arabia; Ali Al Bshabshe, King Khalid University; Reham Alharbi, King Abdulaziz Medical City; Fahad Al-Hameed, King Saud Bin Abdulaziz Univ Hlth Sci; Alyaa Elhazmi, Dr. Sulaiman Al-Habib Medical Group; Reem S Almaghrabi, King Faisal Specialist Hospital and Research Center; Fahad Almaghlouth, King Abdulaziz University; Malak Abedalthagafi, King Fahad Medical City; Noor Al Khathlan, Imam Abdulrahman Bin Faisal University; Faisal A Al-Suwaidan, Ministry of Health, Saudi Arabia; Reem F Bunyan, Center for Improving Value in Health, Saudi Arabia; Bandar Baw, McMaster University; Ghassan Alghamdi, King Saud Bin Abdulaziz University for Health Sciences; Manal Al Hazmi, King Fahad Specialist Dammam; Yasser Mandourah, Ministry of Defense, Saudi Arabia; Abdullah Assiri, Ministry of Health, Riyadh, Saudi Arabia; Mushira Enani, King Fahad Medical City; Maha Alawi, King Abdulaziz University; Reem Aljindan, Imam Abdulrahman Bin Faisal University; Ahmed Aljabbary, Secur Forces Hosp Program Riyadh; Abdullah Alrbiaan, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Fahd Algurashi, Johns Hopkins Aramco Healthcare; Abdulmohsen Alsaawi, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia; Thamer H Alenazi, Ministry of National Guard–Health Affairs, Riyadh, Saudi Arabia; Mohammed A Alsultan, Saudi Commission for Health Specialities; Saleh A Alqahtani, King Faisal Specialist Hosp & Res Ctr; Jaffar A Al-Tawfiq, Indiana University School of Medicine; Ahmed Al-jedai, Alfaisal University
• Journal Title: JOURNAL OF INFECTION AND PUBLIC HEALTH
• Volume: Volume 15, Number 1
• Publisher: ELSEVIER SCIENCE LONDON | 2022-01-01, Pages 142-151
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1016/j.jiph.2021.10.005
• Subjects: Health Sciences, Medicine and Surgery; Environmental Sciences
• Keywords: Science & Technology; Life Sciences & Biomedicine; Public, Environmental & Occupational Health; Infectious Diseases; COVID-19; Therapy; Practice guideline; Intensive care unit; RHEUMATOID-ARTHRITIS; ADVERSE EVENTS; DOUBLE-BLIND; OPEN-LABEL; FAVIPIRAVIR; METAANALYSIS; TOCILIZUMAB; SAFETY; GRADE; MULTICENTER

Abstract

Background: The rapid increase in coronavirus disease 2019 (COVID-19) cases during the subsequent waves in Saudi Arabia and other countries prompted the Saudi Critical Care Society (SCCS) to put together a panel of experts to issue evidence-based recommendations for the management of COVID-19 in the intensive care unit (ICU). Methods: The SCCS COVID-19 panel included 51 experts with expertise in critical care, respirology, infectious disease, epidemiology, emergency medicine, clinical pharmacy, nursing, respiratory therapy, methodology, and health policy. All members completed an electronic conflict of interest disclosure form. The panel addressed 9 questions that are related to the therapy of COVID-19 in the ICU. We identified relevant systematic reviews and clinical trials, then used the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach as well as the evidence-to-decision framework (EtD) to assess the quality of evidence and generate recommendations. Results: The SCCS COVID-19 panel issued 12 recommendations on pharmacotherapeutic interventions (immunomodulators, antiviral agents, and anticoagulants) for severe and critical COVID-19, of which 3 were strong recommendations and 9 were weak recommendations. Conclusion: The SCCS COVID-19 panel used the GRADE approach to formulate recommendations on therapy for COVID-19 in the ICU. The EtD framework allows adaptation of these recommendations in different contexts. The SCCS guideline committee will update recommendations as new evidence becomes available.