INTRODUCTION: Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require noninvasive respiratory support or invasive ventilation . Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes .
METHODS: A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this``living guideline"using the PICO (population, intervention, comparator, outcome) format . The GRADE 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 . Evidence tables 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), the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary 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 monoclonal antibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure . The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir . Conditional recommendations are made against the use of azithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation . No recommendation was made for remdesivir in patients requiring supplemental oxygen . Further recommendations for research are made .
CONCLUSION: The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions . These guidelines will be regularly updated as further evidence becomes available.