Management of hospitalised adults with coronavirus disease 2019 (COVID-19): A European Respiratory Society living guideline

James D. Chalmers (Lead / Corresponding author), Megan L. Crichton, Pieter C. Goeminne, Bin Cao, Marc Humbert, Michal Shteinberg, Katerina M. Antoniou, Charlotte Suppli Ulrik, Helen Parks, Chen Wang, Thomas Vandendriessche, Jieming Qu, Daiana Stolz, Christopher Brightling, Tobias Welte, Stefano Aliberti, Anita K. Simonds, Thomy Tonia, Nicolas Roche

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Introduction: Hospitalised patients with coronavirus disease 2019 (COVID-19) as a result of SARS-CoV-2 infection have a high mortality rate and frequently require noninvasive respiratory support or invasive ventilation. Optimising and standardising management through evidence-based guidelines may improve quality of care and therefore patient outcomes. Methods: A task force from the European Respiratory Society and endorsed by the Chinese Thoracic Society identified priority interventions (pharmacological and non-pharmacological) for the initial version of this “living guideline” using the PICO (population, intervention, comparator, outcome) format. The GRADE approach was used for assessing the quality of evidence and strength of recommendations. Systematic literature reviews were performed, and data pooled by meta-analysis where possible. Evidence tables were presented and evidence to decision frameworks were used to formulate recommendations. Results: Based on the available evidence at the time of guideline development (20 February, 2021), the panel makes a strong recommendation in favour of the use of systemic corticosteroids in patients requiring supplementary oxygen or ventilatory support, and for the use of anticoagulation in hospitalised patients. The panel makes a conditional recommendation for interleukin (IL)-6 receptor antagonist monoclonal antibody treatment and high-flow nasal oxygen or continuous positive airway pressure in patients with hypoxaemic respiratory failure. The panel make strong recommendations against the use of hydroxychloroquine and lopinavir-ritonavir. Conditional recommendations are made against the use of azithromycin, hydroxychloroquine combined with azithromycin, colchicine, and remdesivir, in the latter case specifically in patients requiring invasive mechanical ventilation. No recommendation was made for remdesivir in patients requiring supplemental oxygen. Further recommendations for research are made. Conclusion: The evidence base for management of COVID-19 now supports strong recommendations in favour and against specific interventions. These guidelines will be regularly updated as further evidence becomes available.

Original languageEnglish
Article number2100048
Number of pages20
JournalEuropean Respiratory Journal
Issue number4
Early online date10 Mar 2021
Publication statusPublished - 1 Apr 2021


  • COVID-19
  • coronavirus
  • corticosteroids
  • anti-virals
  • ventilation

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine


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