Background Coronavirus disease 2019 (COVID-19) pandemic has caused unprecedented pressure on healthcare system globally. Lack of high-quality evidence on the respiratory management of COVID-19-related acute respiratory failure (C-ARF) has resulted in wide variation in clinical practice. Methods Using a Delphi process, an international panel of 39 experts developed clinical practice statements on the respiratory management of C-ARF in areas where evidence is absent or limited. Agreement was defined as achieved when > 70% experts voted for a given option on the Likert scale statement or > 80% voted for a particular option in multiple-choice questions. Stability was assessed between the two concluding rounds for each statement, using the non-parametric Chi-square ( χ 2 ) test ( p < 0·05 was considered as unstable). Results Agreement was achieved for 27 (73%) management strategies which were then used to develop expert clinical practice statements. Experts agreed that COVID-19-related acute respiratory distress syndrome (ARDS) is clinically similar to other forms of ARDS. The Delphi process yielded strong suggestions for use of systemic corticosteroids for critical COVID-19; awake self-proning to improve oxygenation and high flow nasal oxygen to potentially reduce tracheal intubation; non-invasive ventilation for patients with mixed hypoxemic-hypercapnic respiratory failure; tracheal intubation for poor mentation, hemodynamic instability or severe hypoxemia; closed suction systems; lung protective ventilation; prone ventilation (for 16–24 h per day) to improve oxygenation; neuromuscular blocking agents for patient-ventilator dyssynchrony; avoiding delay in extubation for the risk of reintubation; and similar timing of tracheostomy as in non-COVID-19 patients. There was no agreement on positive end expiratory pressure titration or the choice of personal protective equipment. Conclusion Using a Delphi method, an agreement among experts was reached for 27 statements from which 20 expert clinical practice statements were derived on the respiratory management of C-ARF, addressing important decisions for patient management in areas where evidence is either absent or limited. Trial registration : The study was registered with Clinical trials.gov Identifier: NCT04534569. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03491-y.
【저자키워드】 Respiratory distress syndrome adult, COVID-19 ventilatory management, COVID-19 respiratory management, COVID-19 acute respiratory distress syndrome, COVID-19 high flow nasal oxygen, COVID 19 invasive mechanical ventilation, 【초록키워드】 COVID-19, Personal protective equipment, Coronavirus disease 2019, ARDS, pandemic, Respiratory failure, Variation, lung, intubation, risk, clinical, management, International, Patient, non-invasive ventilation, agreement, DelPhi, Critical, Likert scale, Clinical practice, Protective, acute respiratory distress, Evidence, Delphi method, suction, Healthcare system, Oxygenation, Non-COVID-19 patients, Prone ventilation, supplementary material, syndrome, Registered, positive, hemodynamic instability, Chi-square, expert, blocking agent, expiratory, IMPROVE, Result, defined, develop, caused, clinically, form, per day, reached, reduce, tracheal, nasal oxygen, systemic corticosteroid, 【제목키워드】 Respiratory failure, management, Delphi method, Consensus, expert,