Surviving Sepsis Campaign Guidelines on the Management of Adults With Coronavirus Disease 2019 (COVID-19) in the ICU

First Update

Waleed Alhazzani; Laura Evans; Fayez Alshamsi; Morten Hylander Møller; Marlies Ostermann; Hallie C. Prescott; Yaseen M. Arabi; Mark Loeb; Michelle Ng Gong; Eddy Fan; Simon Oczkowski; Mitchell M. Levy; Lennie Derde; Amy Dzierba; Bin Du; Flavia Machado; Hannah Wunsch; Mark Crowther; Maurizio Cecconi; Younsuck Koh; Lisa Burry; Daniel S. Chertow; Wojciech Szczeklik; Emilie Belley-Cote; Massimiliano Greco; Malgorzata Bala; Ryan Zarychanski; Jozef Kesecioglu; Allison McGeer; Leonard Mermel; Manoj J. Mammen; Sheila Nainan Myatra; Amy Arrington; Ruth Kleinpell; Giuseppe Citerio; Kimberley Lewis; Elizabeth Bridges; Ziad A. Memish; Naomi Hammond; Frederick G. Hayden; Muhammed Alshahrani; Zainab Al Duhailib; Greg S. Martin; Lewis J. Kaplan; Craig M. Coopersmith; Massimo Antonelli; Andrew Rhodes


Crit Care Med. 2021;49(3):e219-e234. 

In This Article

Abstract and Introduction


Background: The coronavirus disease 2019 pandemic continues to affect millions worldwide. Given the rapidly growing evidence base, we implemented a living guideline model to provide guidance on the management of patients with severe or critical coronavirus disease 2019 in the ICU.

Methods: The Surviving Sepsis Campaign Coronavirus Disease 2019 panel has expanded to include 43 experts from 14 countries; all panel members completed an electronic conflict-of-interest disclosure form. In this update, the panel addressed nine questions relevant to managing severe or critical coronavirus disease 2019 in the ICU. We used the World Health Organization's definition of severe and critical coronavirus disease 2019. The systematic reviews team searched the literature for relevant evidence, aiming to identify systematic reviews and clinical trials. When appropriate, we performed a random-effects meta-analysis to summarize treatment effects. We assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development, and Evaluation approach, then used the evidence-to-decision framework to generate recommendations based on the balance between benefit and harm, resource and cost implications, equity, and feasibility.

Results: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued nine statements (three new and six updated) related to ICU patients with severe or critical coronavirus disease 2019. For severe or critical coronavirus disease 2019, the panel strongly recommends using systemic corticosteroids and venous thromboprophylaxis but strongly recommends against using hydroxychloroquine. In addition, the panel suggests using dexamethasone (compared with other corticosteroids) and suggests against using convalescent plasma and therapeutic anticoagulation outside clinical trials. The Surviving Sepsis Campaign Coronavirus Diease 2019 panel suggests using remdesivir in nonventilated patients with severe coronavirus disease 2019 and suggests against starting remdesivir in patients with critical coronavirus disease 2019 outside clinical trials. Because of insufficient evidence, the panel did not issue a recommendation on the use of awake prone positioning.

Conclusion: The Surviving Sepsis Campaign Coronavirus Diease 2019 panel issued several recommendations to guide healthcare professionals caring for adults with critical or severe coronavirus disease 2019 in the ICU. Based on a living guideline model the recommendations will be updated as new evidence becomes available.


In response to the COVID-19 pandemic, the Surviving Sepsis Campaign (SSC) published recommendations on the management of critically ill coronavirus disease 2019 (COVID-19) patients.[1,2] In view of evolving evidence, the SSC COVID-19 panel convened to issue updated recommendations.