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

ntroduction:Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2infection have a high mortality rate and frequently require noninvasive respiratory support or invasiveventilation. Optimising and standardising management through evidence-based guidelines may improvequality of care and therefore patient outcomes.Methods:A task force from the European Respiratory Society and endorsed by the Chinese ThoracicSociety identified priority interventions (pharmacological and non-pharmacological) for the initial versionof this“living guideline”using the PICO (population, intervention, comparator, outcome) format. TheGRADE 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. Evidencetables were presented and evidence to decision frameworks were used to formulate recommendations.Results:Based on the available evidence at the time of guideline development (20 February, 2021), thepanel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiringsupplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients.The panel makes a conditional recommendation for interleukin (IL)-6 receptor antagonist monoclonalantibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients withhypoxaemic respiratory failure. The panel make strong recommendations against the use ofhydroxychloroquine and lopinavir–ritonavir. Conditional recommendations are made against the use ofazithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the lattercase specifically in patients requiring invasive mechanical ventilation. No recommendation was made forremdesivir in patients requiring supplemental oxygen. Further recommendations for research are made.Conclusion:The evidence base for management of COVID-19 now supports strong recommendations infavour and against specific interventions. These guidelines will be regularly updated as further evidencebecomes available.