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Critical care guidelines inconsistent with WHO recommendations

An analysis of clinical practice guidelines (CPG) for the management of critically ill patients with COVID-19 has found a low level of agreement with recommendations by the World Health Organization (WHO).

In a cross-sectional study, a team from the Department of Pharmacy, Leeds Teaching Hospital and colleagues from Malaysia, reviewed CPGs published as of 30 April 2020 and compared the recommendations contained in these guidelines with those issued from WHO.

The researchers derived 13 reference recommendations from the WHO guidance and checked the extent to which the CPGs were consistent with these recommendations. A literature search yielded a total of 8 CPGs from across the world though there was consistency with only 1 of the 13 WHO reference recommendations, which was for the prescribing of thromboprophylaxis where there were no contraindications. However, several CPGs partially met the recommendations. For example, WHO recommended a target oxygen saturation of >94%, whereas many CPGs though mentioning the need for oxygen therapy did not specify a target level. Furthermore, while WHO discouraged the use of systemic corticosteroids, many CPGs encouraged the use of dexamethasone, after data from the recent RECOVERY trial.

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The authors concluded that these inconsistencies should be addressed as there are potentially important implications for critically ill patients. They also noted that the results from clinical studies specific for COVID-19 should only be included in CPGs where unambiguous.

Kow CS et al. Consistency of recommendations form clinical practice guidelines for the management of critically ill COVID-19 patients. Eur J Hosp Pharm 2020; 31 July 2020. doi: 10.1136/ejhpharm-2020-002388