The new German S2k guideline includes recommendations for the inpatient treatment of patients with COVID-19. It expands the existing intensive care S1 guideline, which has been available since March 2020, to include the inpatient setting and thus provides hospital physicians for the first time with a holistic and interdisciplinary guideline. Three professional societies played a leading role in its preparation – the German Society for Internal Intensive Care and Emergency Medicine (DGIIN), the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) and the German Society for Pneumology and Respiratory Medicine (DGP).
Eleven other professional societies participated in the preparation of the guideline
The increasing number of SARS-CoV-2 infections is also leading to a rapid and relevant increase in hospitalized patients with COVID-19. Structured, safe, and resource-efficient management of these patients in the hospital is therefore essential. “With the new S2k guideline, we have succeeded for the first time in summarizing all therapy recommendations for the inpatient treatment of COVID-19 patients,” explains Professor Stefan Kluge, MD, coordinator of the guideline. “This means we can finally take a holistic and interdisciplinary view of therapy, since all the specialist groups involved were involved in its creation,” said Kluge, who is also director of the Department of Intensive Care Medicine at the University Medical Center Hamburg-Eppendorf. The guideline includes recommendations on the entire course of inpatient treatment – from admission and diagnostics to therapy and the further course of the disease. In addition, many other aspects such as special features in pediatric patients, ethical and palliative care aspects were considered.
The guideline defines when inpatient care is needed and when intensive care is needed. “In patients with pronounced respiratory distress, increased respiratory rate and drop in oxygen saturation, transfer to the intensive care unit is indicated. The guideline already provides hospital staff with recommendations for this phase,” says Professor Christian Karagiannidis, MD, President of the DGIIN and Managing Senior Physician as well as Head of the ECMO Center at the Pulmonary Hospital Cologne-Merheim.
As COVID-19 disease progresses, hypoxemic respiratory insufficiency, problems with gas exchange in the lungs, can occur. “The main goal of supportive therapy is to ensure an adequate supply of oxygen, for which we have various methods, such as oxygen therapy or mask ventilation as a supportive measure,” explains Professor Michael Pfeifer, MD, President of the DGP. The guideline specifies when to use which form of respiratory support and when to use intubation and mechanical ventilation. “In this context, invasive ventilation and repeated abdominal positioning are important elements in the treatment of severely ill COVID-19 patients,” said Pfeifer, University of Regensburg, chief physician at Donaustauf Hospital and Barmherzige Brüder Hospital Regensburg.
“It is also crucial in the inpatient treatment of COVID-19 patients that strict hygiene rules are adhered to, also and especially to protect the staff,” says Professor Uwe Janssens, MD, President of the DIVI and Chief Physician of the Clinic for Internal Medicine and Internal Intensive Care Medicine at the St. Antonius Hospital in Eschweiler. For example, the guideline recommends strict adherence to basic hygiene, including hand hygiene, as well as the correct wearing of adequate personal protective equipment; this is essential when dealing with patients, he said. “This is essential to protect our employees and patients alike,” Janssens emphasizes.
An important chapter deals with drug therapy. “At the beginning of the pandemic, a wide variety of substances were used worldwide without clear data,” said PD Dr. Christoph Spinner, representative of the German Society for Infectious Diseases. “We present the current status of the drugs used in detail in the guideline; mortality reduction has only been demonstrated for dexamethasone in critically ill patients.”
Here you can find the guideline: https://www.awmf.org/leitlinien/detail/ll/113-001.html
Source: German Interdisciplinary Association for Intensive Care and Emergency Medicine e.V.
