Research Priorities for Coronavirus Disease 2019 in Critical Illness

The Surviving Sepsis Campaign

Craig M. Coopersmith, MD, MCCM; Massimo Antonelli, MD; Seth R. Bauer, PharmD, FCCM; Clifford S. Deutschman, MS, MD, MCCM; Laura E. Evans, MD, MSc, FCCM; Ricard Ferrer, MD, PhD; Judith Hellman, MD; Sameer Jog, MD; Jozef Kesecioglu, MD, PhD; Niranjan Kissoon, MB BS, MCCM; Ignacio Martin-Loeches, MD, PhD; Mark E. Nunnally, MD, FCCM; Hallie C. Prescott, MD, MSc; Andrew Rhodes, MB BS, MD(Res); Daniel Talmor, MD, MPH; Pierre Tissieres, MD, DSc; Daniel De Backer, MD, PhD

Disclosures

Crit Care Med. 2021;49(4):598-622. 

In This Article

Methods

Sponsorship

Funding for the research priorities was provided solely by Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM). No outside funding was received.

Organization of the Committee

ESICM and SCCM appointed members (including one cochair D.D.B., C.M.C., respectively) from each society to the committee which included the cochairs of the Surviving Sepsis Campaign adult (L.E.E., A.R.) and pediatric (N.K., P.T.) guidelines. Committee members were chosen based upon expertise in a wide variety of topics ranging from clinical management to long-term outcomes to basic science. Since all committee members specialize in intensive care, the research priorities focus on critical illness caused by COVID-19. This is not meant to minimize other vital aspects of COVID-19 research such as vaccine development to prevent disease or potential outpatient therapies for mild disease but instead is based upon the expertise of the panel and a prespecified desire to further understand both pathology and therapy in the patients most likely to die of COVID-19. In keeping with a commitment to diversity from both SCCM and ESICM, diversity (broadly defined but including geographic, gender, profession, specialty, socioeconomic) was expressly considered when populating the committee. Notably, the committee had representatives from 10 countries, representing both high- and middle-income countries. Further, the committee had representation from a variety of specialties including intensive care (including pulmonary/critical care, surgical critical care, anesthesiology critical care, and pediatric critical care), emergency medicine, and pharmacy.

Determination of Research Questions and Priorities

Each task force member was asked to submit research questions on any subject related to COVID-19 that they felt was most important, explicitly not restricting this to any particular areas. The expectation was this open-ended approach would yield questions spanning the entire potential gamut of research related to COVID-19 in critically ill patients. Committee members submitted between five and nine questions each. After combining proposed questions that were nearly identical, a total of 58 potential questions was created (Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/CCM/G171). The goal was to create questions that were as distinct as possible, with the understanding that there may be some overlap between questions.

The committee was next asked to rank their top seven research priorities in order from these 58 questions. Choices were weighted, so that each respondent's first choice was worth seven points, second choice was worth six points, etc. This allowed for a weighted ranking based upon 1) the number of panel members who rated a question as a top priority and 2) the relative prioritization of each panel member. The number of points for each research priority is shown in Supplemental Table 2 (Supplemental Digital Content 2, http://links.lww.com/CCM/G172). There was no a priori decision about how many priorities would be listed. Instead, the final priority list is based upon a cutoff determined by the cochairs related to the number of votes and weighting of the votes for what constituted broad support for a question posed to the committee. The verbiage of each question presented here was simplified compared with the original (compare Supplemental Table 1, Supplemental Digital Content 1, http://links.lww.com/CCM/G171 with Table 1) for the ease of readability. Each question was originally written by a single panel member and then reviewed by the entire panel. All but one question used the format that the Surviving Sepsis Research Committee has used in previous publications of 1) What is known, 2) Gaps in knowledge, and 3) Future directions[8–11] The one exception was the question "how can quality research be performed and assessed during a pandemic?" Since this question directly relates to all 12 research priorities—and all research in general during COVID-19—we opted to address this in a broader manner that is not constrained by the format used for all other questions in a separate discussion that follows the remaining questions. In addition, the cochairs decided to limit the scope of the "What Is Known" section to studies that have undergone peer review as of manuscript submission date and not include studies that have been disseminated via press release or preprint servers. The single exception to this was the SOLIDARITY trial, a, 11,266 patient randomized controlled trial of repurposed antiviral drugs which we have included due to its size with the explicit caveat that the trial has not yet undergone peer review.[12]

Conflict of Interest Policy

No industry input into the research priorities was obtained, and no members of the research committee received financial compensation or honoraria for their participation. The process relied on a pre-existing conflict of interest policy and personal disclosure for the Surviving Sepsis Campaign research priorities for sepsis that was updated for this article.[8,9]

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