NICE publishes first rapid COVID-19 guidelines – critical care

The guideline is intended to maximise the safety of patients who need critical care during the COVID-19 pandemic, whilst also protecting staff from infection. It sets out the following recommendations:

1.    Admission to hospital

• On admission to hospital, all adults should be assessed for frailty, irrespective of their age and COVID-19 status. Regard should be had to any comorbidities and underlying health conditions.
• If a patient is identified as potentially having COVID-19, the UK Government guidance on infection prevention and control measures should be followed.
• If COVID-19 is then diagnosed in someone who is not isolated from admission or presentation, the UK Government guidance on actions required when a case was not diagnosed on admission should be followed.

2.    Admission to critical care

• On admission to critical care, the risks, benefits and likely outcomes of the different treatment options should be discussed with patients, families and carers so they can make informed decisions about their treatment wherever possible.
• A member of the critical care team should be involved in these discussions whenever the patient or team needs advice about critical care to make decisions about treatment.

3.    Starting, reviewing and stopping critical care treatment

• Start critical care treatment with a clear plan of how the treatment will address the diagnosis and lead to agreed outcomes.
• Review critical care treatment regularly and when the patient’s clinical condition changes.
• Stop critical care treatment when it is no ;longer considered able to achieve the desired outcomes. Record the decision and the discussion with family, carers and the patient (if possible).

4.    Clinical decision-making

• Be alert to the fact that guidance on treating COVID-19 may change with emerging knowledge/scientific data and this may require subsequent modifications to treatment.
• Critical care staff should support healthcare professionals who do not routinely work in critical care but need to do so.

5.    Service organisation

• Trusts should allow for telephone advice rather than face-to-face review from critical care when clinically appropriate.
• Hospitals should discuss the sharing of resources and the transfer of patients between units, including units in other hospitals, to ensure the best use of critical care within the NHS.

Please note, the above is intended to provide a summary of the key recommendations which emerge from this guidance. Access to the full guidance can be found here.

If you have any queries in relation to this guidance, or would like any further information, please get in touch.