International variation in the management of severe COVID-19 patients
International variation in the management of severe COVID-19 patients
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DOI：
10.1186/s13054-020-03194-w
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发表时间：
2020-08-05
期刊：
影响因子：
15.1
通讯作者：
Cecconi, Maurizio
中科院分区：
文献类型：
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作者：
Azoulay, Elie;de Waele, Jan;Cecconi, Maurizio
背景几乎没有证据支持严重COVID-19患者的管理。方法为了记录这种做法的变化，我们代表欧洲重症监护医学会（ESICM）进行了一项在线调查（2020年4月30日至5月25日）。向ESICM成员发送了一份案例简介。问题调查了一名先前健康的39岁患者的做法，该患者因COVID-19感染而出现严重低氧血症。结果共有来自85个国家（12个地区）的1132名ICU专家（应答率20%）回答了调查。该调查提供了关于患者管理异质性的信息，特别是关于ICU入院时间、一线氧合策略、管理优化和难治性低氧血症情况下的治疗设置。与抗菌，抗病毒和抗炎治疗相关的实践也进行了调查。结论重症COVID-19患者的管理存在重要的实践差异，包括区域和个体水平的差异。需要进行基于多国登记的大型结局研究。
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.