International variation in the management of severe COVID-19 patients
Elie Azoulay,
Jan de Waele,
Ricard Ferrer,
Thomas Staudinger,
Marta Borkowska,
Pedro Povoa,
Katerina Iliopoulou,
Antonio Artigas,
Stefan J. Schaller,
Manu Shankar-Hari,
Mariangela Pellegrini,
Michael Darmon,
Jozef Kesecioglu,
Maurizio Cecconi
Affiliations
Elie Azoulay
Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University
Jan de Waele
Department of Critical Care Medicine, Ghent University Hospital
Ricard Ferrer
Shock, Organ Dysfunction, and Resuscitation Research Group (SODIR), Instituto de Investigación de Vall d’Hebron
Thomas Staudinger
Department of Medicine I, Intensive Care Unit, Medical University of Vienna, Vienna General Hospital
Marta Borkowska
Department of Critical Care Medicine, Ghent University Hospital
Pedro Povoa
NOVA Medical School, CHRC, New University of Lisbon, Unidade de Cuidados Intensivos Polivalente, Hospital de São Francisco Xavier, CHLO, Estrada Do Forte Do Alto Do Duque
Katerina Iliopoulou
Hellenic Army, ICU Nurse Manager General Military Hospital
Antonio Artigas
Critical Care Center, Sabadell Hospital, University Institute Parc Taulí, Autonomous University of Barcelona, Ciberes
Stefan J. Schaller
Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Department of Anesthesiology and Surgical Intensive Care
Manu Shankar-Hari
School of Immunology and Microbial Science, Kings College London. Guy’s and St Thomas’ NHS Foundation Trust, ICU Support Offices, St Thomas’ Hospital
Mariangela Pellegrini
Department of Surgical Sciences and Central Intensive Care Unit, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg
Michael Darmon
Médecine Intensive et Réanimation, Department of the St-Louis Hospital, APHP, Hôpital Saint-Louis, Paris University
Jozef Kesecioglu
Department of Intensive Care Medicine, Division of Anesthesiology, Intensive Care and Emergency Medicine, University Medical Center Utrecht, Utrecht University
Maurizio Cecconi
Humanitas Clinical and Research Center, Humanitas University
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.
