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【肺炎】首个新冠肺炎暂行指导发布，来自20个国家80位临床专家共同完成



【肺炎】首个新冠肺炎暂行指导发布，来自20个国家80位临床专家共同完成
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由美国、新加坡、中国和西班牙等20个国家共80位临床专家组成的新型冠状病毒病国际工作组共同完成的新型冠状病毒病治疗暂行指导由美国胸科学会发布 。
该工作组表示 ， 对于住院的COVID患者 ， 视患者具体情况可规范使用羟氯喹或氯喹 。 但临床医生必须讨论治疗的潜在风险和益处 ， 并收集好治疗的结局指标 。
对于不需住院的门诊患者或没有肺炎的住院COVID患者 ， 工作组对支持或反对使用羟氯喹或氯喹不给出建议 。 对于其他潜在的治疗药物 ， 工作者亦拒绝表明立场 。
工作组明确建议 ， 肺炎持续加重且出现难治性低氧血症（如急性呼吸窘迫综合征 ， ARDS）的COVID患者 ， 应给予俯卧位机械通气；如果俯卧位机械通气仍不能改善 ， 则进行体外膜氧合（ECMO）治疗 。
需要注意的是 ， Interim Guidance肯定不是指南（guideline） ， 后者需要有充分的临床试验证据 ， 尤其是RCT研究结果；但这是目前对COVID-19治疗方案的最佳理解 。
原文：
COVID‐19: Interim Guidance on Management Pending Empirical Evidence. From an American Thoracic Society‐led International Task Force
Abstract
Background: Coronavirus Disease 2019 (COVID‐19) is an acute respiratory disease caused by the
coronavirus, SARS‐CoV‐2. There is a paucity of empirical evidence to guide the management of COVID‐19, but clinical observations are accumulating. Consensus recommendations can help standardize care and improve outcomes.
Methods: An International Task Force was composed, consisting of clinicians from academic centers active in COVID‐19 patient care. Consensus suggestions were derived using the electronic decision‐making portion of the Convergence of Opinion on Recommendations and Evidence (CORE) process.
Results: The task force recommended collecting data and comparing outcomes among COVID‐19 patients who received an intervention to those who did not receive the intervention using appropriate methods for causal inference and control of confounders. Suggestions were made to treat hospitalized patients who have COVID‐19 and severe pneumonia with hydroxychloroquine or chloroquine on a case‐by‐case basis if certain requirements are present, and to utilize prone ventilation and extracorporeal membrane oxygenation (ECMO) in patients with refractory hypoxemia due to COVID‐19 pneumonia (i.e., acute respiratory distress syndrome [ARDS]). The task force made no suggestions for or against treatment with remdesivir, lopinavir‐ritonavir, tocilizumab, or systemic corticosteroids.
Conclusions: The task force made suggestions based upon scarce direct evidence, indirect evidence, and clinical experience. Each suggestion will be reconsidered as relevant evidence, particularly randomized trials, are published.
Citation: Wilson KC, Chotirmall SH, Bai C, Rello J. COVID‐19: Interim Guidance on Management Pending Empirical Evidence. Last updated April 3, 2020. Available at www.thoracic.org/professionals/clinical‐resources/disease‐related‐resources/covid‐19‐guidance.pdf.
原文链接：https://www.thoracic.org/professionals/clinical-resources/disease-related-resources/covid-19-guidance.pdf


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