Rhodes A, Evans LE, Alhazzani W, Levy MM, et al. Surviving Sepsis Campaign: International Guidelines for Management of Sepsis and Septic Shock: 2016. Crit Care Med. 2017 Mar;45(3):486-552.
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Methods: The panel consisted of five sections: hemodynamics, infection, adjunctive therapies, metabolic, and ventilation. Population, intervention, comparison, and outcomes (PICO) questions were reviewed and updated as needed, and evidence profiles were generated. Each subgroup generated a list of questions, searched for best available evidence, and then followed the principles of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system to assess the quality of evidence from high to very low, and to formulate recommendations as strong or weak, or best practice statement when applicable.
Ellison RT. Surgical complications in patients with COVID-19. NEJM Journal Watch, June 2, 2020.
“During the COVID-19 pandemic, most hospitals have suspended nonemergent surgeries. However, an increasing number of patients need urgent and semiurgent procedures, and there are economic incentives to restart elective surgery. Thus, it is critically important to know how COVID-19 affects surgical outcomes. An international observational study has assessed 30-day mortality and pulmonary complications in patients with COVID-19 undergoing surgery at 235 hospitals between January 1 and March 31, 2020. The infection was identified between 7 days before and 30 days after the procedure.
Among 1128 patients identified, 835 (74%) underwent emergency surgery, and 280, elective surgery. COVID-19 was diagnosed preoperatively in 294 (26%) and was confirmed by SARS-CoV-2 RNA detection in 969 (86%). The overall 30-day mortality rate was 24%; for elective procedures, 19%. Mortality was higher in men, patients over 70 years of age, ASA grades 3–5, malignancy, and with emergency and major surgical procedures. Pulmonary complications developed in 577 patients (51%) and were associated with a higher 30-day mortality rate.”
Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 11. doi: 10.1016/S0140-6736(20)30566-3. [Epub ahead of print]
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“191 patients (135 from Jinyintan Hospital and 56 from Wuhan Pulmonary Hospital) were included in this study, of whom 137 were discharged and 54 died in hospital. 91 (48%) patients had a comorbidity, with hypertension being the most common (58 [30%] patients), followed by diabetes (36 [19%] patients) and coronary heart disease (15 [8%] patients). Multivariable regression showed increasing odds of in-hospital death associated with older age (odds ratio 1·10, 95% CI 1·03-1·17, per year increase; p=0·0043), higher Sequential Organ Failure Assessment (SOFA) score (5·65, 2·61-12·23; p<0·0001), and d-dimer greater than 1 μg/L (18·42, 2·64-128·55; p=0·0033) on admission. Median duration of viral shedding was 20·0 days (IQR 17·0-24·0) in survivors, but SARS-CoV-2 was detectable until death in non-survivors. The longest observed duration of viral shedding in survivors was 37 days.”