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COVID-19: Guidelines, Statements, and Research

Access guidelines, statements, and key research related to the management of patients with COVID-19 and the delivery of critical care during the pandemic.


National Institutes of Health COVID-19 Treatment Guidelines

These evolving guidelines from NIH provide recommendations based on scientific evidence and expert opinion as determined by a panel of representatives from federal agencies, health care and academic organizations, and professional societies, including CHEST members Steven Q. Simpson, MD, FCCP; Mitchell M. Levy, MD; and Gregory S. Martin, MD, MSc, FCCP.

 

The US Strategic National Stockpile (SNS) Ventilators in COVID-19: A Comparison of Functionality and Analysis Regarding the Emergency Purchase of 200,000 Devices

Journal CHEST
September 20, 2020

Ventilators

New York City and Boston were severely affected with the onset of the COVID-19 pandemic in March-April 2020. Pre-existing Strategic National Stockpile (SNS) ventilators were used to treat patients in these areas; but with concerns of a shortage, the US government, under the Defense Production Act, initially ordered about 200,000 new ventilators (subsequently decreased to 130,000 in August 2020).

  • Fifteen different types of ventilators were ordered from 11 manufacturers, and these efforts provided an additional stockpile of new SNS ventilators that would be available for use if the pandemic surged again to severe levels.
  • Patients with COVID-19 had varying degrees of respiratory failure, up to severe ARDS. Pre-existing SNS ventilators worked well for most, but not all, of these patients.
  • Most importantly, only some of the new SNS ventilators have the functional capability to support all COVID-19 patients; the remaining ventilators have other important uses, including care of less severely ill patients, transport, and noninvasive ventilation.
  • It is crucial that professionals who may be receiving or ordering these new SNS ventilators (including those being sent to other countries) understand the functionality and limitations of the ventilators.
  • The addition of 15 different types of ventilators to the SNS creates challenges for ongoing maintenance, including considerable costs and training of end users.

Drug shortages

It Takes a Village… Contending With Drug Shortages During Disasters

Journal CHEST
August 13, 2020

Drug shortages have become more common in recent years. A recent article published in the journal CHEST outlines methods for health systems to mitigate common drug shortages, as well as strategies for medication substitution in times of shortage.

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Recovery Trial

Dexamethasone in Hospitalized Patients with COVID-19—Preliminary Report

New England Journal of Medicine
July 17, 2020

According to results from the RECOVERY Trial, published in the New England Journal of Medicine, dexamethasone is the first therapeutic agent shown to reduce mortality due to COVID-19. Review the key takeaways from this trial.

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Joint Statement on Importance of Wearing Facial Coverings

American College of Chest Physicians, American Lung Association, American Thoracic Society, and COPD Foundation
July 17, 2020

CHEST has joined with the American Lung Association, American Thoracic Society, and COPD Foundation to release a statement on the importance of patients with chronic lung disease wearing facial coverings during the COVID-19 pandemic. Key points of the statement include:

  • The role of the facial coverings as a component of mitigation, along with social distancing, to decrease the spread of COVID-19 is a public health priority.
  • The general public should avoid using N95 masks so as to not deplete this resource for frontline workers.
  • Though face masks and face shields should not be viewed interchangeably, available data suggest face shields can reduce the amount of inhalation exposure to another droplet-spread respiratory virus, namely influenza.
  • Individuals with normal lungs and even many individuals with underlying chronic lung disease should be able to wear a non-N95 facial covering without affecting their oxygen or carbon dioxide levels.

Use of Tracheostomy During the COVID-19 Pandemic: CHEST/AABIP/AIPPD: Expert Panel Report

American College of Chest Physicians
June 5, 2020

This expert panel report examines the current evidence for performing tracheostomy in patients with respiratory failure from COVID-19 and provides recommendations to guide health-care providers, including the following:

  • Either open surgical tracheostomy or percutaneous dilatational tracheostomy can be performed in COVID-19 patients when prolonged mechanical ventilation is anticipated.
  • Tracheostomy should be performed in a negative-pressure room, preferably in the ICU, by a team consisting of the least number of providers with the highest level of experience wearing enhanced personal protective equipment.
  • There is insufficient evidence for recommending specific timing for tracheostomy in COVID-19-related respiratory failure.
  • Routine RT-PCR testing (nasopharyngeal swab or lower respiratory sample) prior to performing tracheostomy in patients with confirmed COVID-19-related respiratory failure is not recommended.
  • Patients should be maintained with a closed circuit while on mechanical ventilation with a tracheostomy tube and with inline suction.

 

 

Recommendations from CHEST Journal Articles

Surge Capacity Principles

Surge Capacity Logistics

Evacuation of the ICU

Triage

Special Populations

System-Level Planning, Coordination, and Communication

Business and Continuity of Operations

Engagement and Education

Legal Preparedness

Ethical Considerations

Resource-Poor Settings: Infrastructure and Capacity Building

Resource-Poor Settings: Response, Recovery, and Research