RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

Mark Griffiths; Susanna Meade; Charlotte Summers; Daniel Francis McAuley; Alastair Proudfoot; Marta Montero Baladia; Paul M Dark; Kate Diomede; Simon J Finney; Lui G Forni; Chris Meadows; Ian A Naldrett; Brijesh Patel; Gavin D Perkins; Mark A Samaan; Laurence Sharifi; Ganesh Suntharalingam; Nicholas T Tarmey; Harriet F Young; Matt P Wise; Peter M Irving

doi:10.1136/thoraxjnl-2021-216904

RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

Mark Griffiths, Susanna Meade, Charlotte Summers, Daniel Francis McAuley, Alastair Proudfoot, Marta Montero Baladia, Paul M Dark, Kate Diomede, Simon J Finney, Lui G Forni, Chris Meadows, Ian A Naldrett, Brijesh Patel, Gavin D Perkins, Mark A Samaan, Laurence Sharifi, Ganesh Suntharalingam, Nicholas T Tarmey, Harriet F Young, Matt P WisePeter M Irving

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

Abstract

Background:
COVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from ‘classical’ ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template.

Methods:
An 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1–9 (where 1–3 is inappropriate, 4–6 is uncertain and 7–9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into investigations (16), non-invasive respiratory support (18), basic intensive care unit management of ARDS (20), management of refractory hypoxaemia (8), pharmacotherapy (7) and anticoagulation (7), was completed again.

Results:
Disagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For patients with ARDS with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous thromboembolic disease.

Conclusion:
The expert panel found no reason to deviate from the evidence-based supportive strategies for managing ARDS outlined in recent guidelines.

Original language	English
Pages (from-to)	129-135
Journal	Thorax
Volume	77
Issue number	2
Early online date	27 May 2021
DOIs	https://doi.org/10.1136/thoraxjnl-2021-216904
Publication status	Published - 12 Jan 2022

Keywords

ARDS
COVID-19
assisted ventilation
critical care
non invasive ventilation
viral infection

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Cite this

Griffiths, M., Meade, S., Summers, C., McAuley, D. F., Proudfoot, A., Baladia, M. M., Dark, P. M., Diomede, K., Finney, S. J., Forni, L. G., Meadows, C., Naldrett, I. A., Patel, B., Perkins, G. D., Samaan, M. A., Sharifi, L., Suntharalingam, G., Tarmey, N. T., Young, H. F., ... Irving, P. M. (2022). RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic. Thorax, 77(2), 129-135. https://doi.org/10.1136/thoraxjnl-2021-216904

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title = "RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic",

abstract = "Background:COVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from {\textquoteleft}classical{\textquoteright} ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template.Methods:An 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1–9 (where 1–3 is inappropriate, 4–6 is uncertain and 7–9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into investigations (16), non-invasive respiratory support (18), basic intensive care unit management of ARDS (20), management of refractory hypoxaemia (8), pharmacotherapy (7) and anticoagulation (7), was completed again.Results:Disagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For patients with ARDS with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous thromboembolic disease.Conclusion:The expert panel found no reason to deviate from the evidence-based supportive strategies for managing ARDS outlined in recent guidelines.",

keywords = "ARDS, COVID-19, assisted ventilation, critical care, non invasive ventilation, viral infection",

author = "Mark Griffiths and Susanna Meade and Charlotte Summers and McAuley, {Daniel Francis} and Alastair Proudfoot and Baladia, {Marta Montero} and Dark, {Paul M} and Kate Diomede and Finney, {Simon J} and Forni, {Lui G} and Chris Meadows and Naldrett, {Ian A} and Brijesh Patel and Perkins, {Gavin D} and Samaan, {Mark A} and Laurence Sharifi and Ganesh Suntharalingam and Tarmey, {Nicholas T} and Young, {Harriet F} and Wise, {Matt P} and Irving, {Peter M}",

year = "2022",

month = jan,

day = "12",

doi = "10.1136/thoraxjnl-2021-216904",

language = "English",

volume = "77",

pages = "129--135",

journal = "Thorax",

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Griffiths, M, Meade, S, Summers, C, McAuley, DF, Proudfoot, A, Baladia, MM, Dark, PM, Diomede, K, Finney, SJ, Forni, LG, Meadows, C, Naldrett, IA, Patel, B, Perkins, GD, Samaan, MA, Sharifi, L, Suntharalingam, G, Tarmey, NT, Young, HF, Wise, MP & Irving, PM 2022, 'RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic', Thorax, vol. 77, no. 2, pp. 129-135. https://doi.org/10.1136/thoraxjnl-2021-216904

RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic. / Griffiths, Mark; Meade, Susanna; Summers, Charlotte et al.
In: Thorax, Vol. 77, No. 2, 12.01.2022, p. 129-135.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

AU - Griffiths, Mark

AU - Meade, Susanna

AU - Summers, Charlotte

AU - McAuley, Daniel Francis

AU - Proudfoot, Alastair

AU - Baladia, Marta Montero

AU - Dark, Paul M

AU - Diomede, Kate

AU - Finney, Simon J

AU - Forni, Lui G

AU - Meadows, Chris

AU - Naldrett, Ian A

AU - Patel, Brijesh

AU - Perkins, Gavin D

AU - Samaan, Mark A

AU - Sharifi, Laurence

AU - Suntharalingam, Ganesh

AU - Tarmey, Nicholas T

AU - Young, Harriet F

AU - Wise, Matt P

AU - Irving, Peter M

PY - 2022/1/12

Y1 - 2022/1/12

N2 - Background:COVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from ‘classical’ ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template.Methods:An 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1–9 (where 1–3 is inappropriate, 4–6 is uncertain and 7–9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into investigations (16), non-invasive respiratory support (18), basic intensive care unit management of ARDS (20), management of refractory hypoxaemia (8), pharmacotherapy (7) and anticoagulation (7), was completed again.Results:Disagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For patients with ARDS with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous thromboembolic disease.Conclusion:The expert panel found no reason to deviate from the evidence-based supportive strategies for managing ARDS outlined in recent guidelines.

AB - Background:COVID-19 has become the most common cause of acute respiratory distress syndrome (ARDS) worldwide. Features of the pathophysiology and clinical presentation partially distinguish it from ‘classical’ ARDS. A Research and Development (RAND) analysis gauged the opinion of an expert panel about the management of ARDS with and without COVID-19 as the precipitating cause, using recent UK guidelines as a template.Methods:An 11-person panel comprising intensive care practitioners rated the appropriateness of ARDS management options at different times during hospital admission, in the presence or absence of, or varying severity of SARS-CoV-2 infection on a scale of 1–9 (where 1–3 is inappropriate, 4–6 is uncertain and 7–9 is appropriate). A summary of the anonymised results was discussed at an online meeting moderated by an expert in RAND methodology. The modified online survey comprising 76 questions, subdivided into investigations (16), non-invasive respiratory support (18), basic intensive care unit management of ARDS (20), management of refractory hypoxaemia (8), pharmacotherapy (7) and anticoagulation (7), was completed again.Results:Disagreement between experts was significant only when addressing the appropriateness of diagnostic bronchoscopy in patients with confirmed or suspected COVID-19. Adherence to existing published guidelines for the management of ARDS for relevant evidence-based interventions was recommended. Responses of the experts to the final survey suggested that the supportive management of ARDS should be the same, regardless of a COVID-19 diagnosis. For patients with ARDS with COVID-19, the panel recommended routine treatment with corticosteroids and a lower threshold for full anticoagulation based on a high index of suspicion for venous thromboembolic disease.Conclusion:The expert panel found no reason to deviate from the evidence-based supportive strategies for managing ARDS outlined in recent guidelines.

KW - ARDS

KW - COVID-19

KW - assisted ventilation

KW - critical care

KW - non invasive ventilation

KW - viral infection

U2 - 10.1136/thoraxjnl-2021-216904

DO - 10.1136/thoraxjnl-2021-216904

M3 - Article

C2 - 34045363

SN - 0040-6376

VL - 77

SP - 129

EP - 135

JO - Thorax

JF - Thorax

IS - 2

ER -

RAND appropriateness panel to determine the applicability of UK guidelines on the management of acute respiratory distress syndrome (ARDS) and other strategies in the context of the COVID-19 pandemic

Abstract

Keywords

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