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Vickers AJ, Van Claster B, Wynants L, Steyerberg EW. Decision curve analysis: confidence intervals and hypothesis testing for net benefit. Diagn Progn Res 2023; 7:11. [PMID: 37277840 PMCID: PMC10243069 DOI: 10.1186/s41512-023-00148-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 04/25/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND A number of recent papers have proposed methods to calculate confidence intervals and p values for net benefit used in decision curve analysis. These papers are sparse on the rationale for doing so. We aim to assess the relation between sampling variability, inference, and decision-analytic concepts. METHODS AND RESULTS We review the underlying theory of decision analysis. When we are forced into a decision, we should choose the option with the highest expected utility, irrespective of p values or uncertainty. This is in some distinction to traditional hypothesis testing, where a decision such as whether to reject a given hypothesis can be postponed. Application of inference for net benefit would generally be harmful. In particular, insisting that differences in net benefit be statistically significant would dramatically change the criteria by which we consider a prediction model to be of value. We argue instead that uncertainty related to sampling variation for net benefit should be thought of in terms of the value of further research. Decision analysis tells us which decision to make for now, but we may also want to know how much confidence we should have in that decision. If we are insufficiently confident that we are right, further research is warranted. CONCLUSION Null hypothesis testing or simple consideration of confidence intervals are of questionable value for decision curve analysis, and methods such as value of information analysis or approaches to assess the probability of benefit should be considered instead.
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Affiliation(s)
- Andrew J Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| | - Ben Van Claster
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
- EPI-Centre, KU Leuven, Louvain, Belgium
| | - Laure Wynants
- Department of Development and Regeneration, KU Leuven, Louvain, Belgium
- EPI-Centre, KU Leuven, Louvain, Belgium
- Department of Epidemiology, CAPHRI Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands
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Foggin H, Metcalfe R, Hutcheon JA, Bansback N, Burrows J, Karacebeyli E, Shivananda S, Boutin A, Liauw J. Understanding what patients and physicians need to improve their decision-making about antenatal corticosteroids in late preterm gestation: a qualitative framework analysis. CMAJ Open 2023; 11:E466-E474. [PMID: 37220957 DOI: 10.9778/cmajo.20220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND It is unclear whether the benefits of administration of antenatal corticosteroids in late preterm gestation outweigh its harms. We sought to understand whether patients and physicians need increased support to decide whether to administer antenatal corticosteroids in late preterm gestation, and their informational needs and preferences for decision-making roles related to this intervention; we also wanted to know if creation of a decision-support tool would be useful. METHODS We conducted individual, semistructured interviews with pregnant people, obstetricians and pediatricians in Vancouver, Canada, in 2019. Using a qualitative framework analysis method, we coded, charted and interpreted interview transcripts into categories that formed an analytical framework. RESULTS We included 20 pregnant participants, 10 obstetricians and 10 pediatricians. We organized codes into the following categories: informational needs to decide whether to administer antenatal corticosteroids; preferences for decision-making roles regarding this treatment; the need for support to make this treatment decision; and the preferred format and content of a decision-support tool. Pregnant participants wanted to be involved in decision-making about antenatal corticosteroids in late preterm gestation. They wanted information on the medication, respiratory distress, hypoglycemia, parent-neonate bonding and long-term neurodevelopment. There was variation in physician counselling practices, and in how patients and physicians perceived the balance of treatment harms and benefits. Responses suggested a decision-support tool may be useful. Participants desired clear descriptions of risk magnitude and uncertainty. INTERPRETATION Pregnant people and physicians would likely benefit from increased support to consider the harms and benefits of antenatal corticosteroids in late preterm gestation. Creation of a decision-support tool may be useful.
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Affiliation(s)
- Hannah Foggin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Rebecca Metcalfe
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jennifer A Hutcheon
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Nick Bansback
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jason Burrows
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Eda Karacebeyli
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Sandesh Shivananda
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Amelie Boutin
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
| | - Jessica Liauw
- Department of Obstetrics and Gynaecology (Foggin, Hutcheon, Burrows, Karacebeyli, Boutin, Liauw); School of Population and Public Health (Metcalfe, Bansback); Department of Pediatrics (Shivananda), University of British Columbia, Vancouver, BC
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3
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Resende MHF, Yarnell CJ, D'Souza R, Lapinsky SE, Nam A, Shah V, Whittle W, Wright JK, Naimark DMJ. Clinical decision analysis of elective delivery vs expectant management for pregnant individuals with COVID-19-related acute respiratory distress syndrome. Am J Obstet Gynecol MFM 2022; 4:100697. [PMID: 35878805 PMCID: PMC9307282 DOI: 10.1016/j.ajogmf.2022.100697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Pregnant individuals are vulnerable to COVID-19-related acute respiratory distress syndrome. There is a lack of high-quality evidence on whether elective delivery or expectant management leads to better maternal and neonatal outcomes. OBJECTIVE This study aimed to determine whether elective delivery or expectant management are associated with higher quality-adjusted life expectancy for pregnant individuals with COVID-19-related acute respiratory distress syndrome and their neonates. STUDY DESIGN We performed a clinical decision analysis using a patient-level model in which we simulatedpregnant individuals and their unborn children. We used a patient-level model with parallel open-cohort structure, daily cycle length, continuous discounting, lifetime horizon, sensitivity analyses for key parameter values, and 1000 iterations for quantification of uncertainty. We simulated pregnant individuals at 32 weeks of gestation, invasively ventilated because of COVID-19-related acute respiratory distress syndrome. In the elective delivery strategy, pregnant individuals received immediate cesarean delivery. In the expectant management strategy, pregnancies continued until spontaneous labor or obstetrical decision to deliver. For both pregnant individuals and neonates, model outputs were hospital or perinatal survival, life expectancy, and quality-adjusted life expectancy denominated in years, summarized by the mean and 95% credible interval. Maternal utilities incorporated neonatal outcomes in accordance with best practices in perinatal decision analysis. RESULTS Model outputs for pregnant individuals were similar when comparing elective delivery at 32 weeks' gestation with expectant management, including hospital survival (87.1% vs 87.4%), life-years (difference, -0.1; 95% credible interval, -1.4 to 1.1), and quality-adjusted life expectancy denominated in years (difference, -0.1; 95% credible interval, -1.3 to 1.1). For neonates, elective delivery at 32 weeks' gestation was estimated to lead to a higher perinatal survival (98.4% vs 93.2%; difference, 5.2%; 95% credible interval, 3.5-7), similar life-years (difference, 0.9; 95% credible interval, -0.9 to 2.8), and higher quality-adjusted life expectancy denominated in years (difference, 1.3; 95% credible interval, 0.4-2.2). For pregnant individuals, elective delivery was not superior to expectant management across a range of scenarios between 28 and 34 weeks of gestation. Elective delivery in cases where intrauterine death or maternal mortality were more likely resulted in higher neonatal quality-adjusted life expectancy, as did elective delivery at 30 weeks' gestation (difference, 1.1 years; 95% credible interval, 0.1 - 2.1) despite higher long-term complications (4.3% vs 0.5%; difference, 3.7%; 95% credible interval, 2.4-5.1), and in cases where intrauterine death or maternal acute respiratory distress syndrome mortality were more likely. CONCLUSION The decision to pursue elective delivery vs expectant management in pregnant individuals with COVID-19-related acute respiratory distress syndrome should be guided by gestational age, risk of intrauterine death, and maternal acute respiratory distress syndrome severity. For the pregnant individual, elective delivery is comparable but not superior to expectant management for gestational ages from 28 to 34 weeks. For neonates, elective delivery was superior if gestational age was ≥30 weeks and if the rate of intrauterine death or maternal mortality risk were high. We recommend basing the decision for elective delivery vs expectant management in a pregnant individual with COVID-19-related acute respiratory distress syndrome on gestational age and likelihood of intrauterine or maternal death.
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Affiliation(s)
- Maura H Ferrari Resende
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark)
| | - Christopher J Yarnell
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky).
| | - Rohan D'Souza
- Departments of Obstetrics and Gynecology and Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada (Dr D'Souza); Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Stephen E Lapinsky
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Critical Care Medicine, Sinai Health System and the University Health Network, Toronto, Canada (Dr Yarnell and Dr Lapinsky); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | | | - Vibhuti Shah
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada (Dr Shah)
| | - Wendy Whittle
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynaecology, Sinai Health System, University of Toronto, Toronto, Canada (Drs D'Souza and Whittle)
| | - Julie K Wright
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada (Dr Wright); Division of Infectious Diseases, Department of Medicine, University of Toronto, Toronto, Canada (Dr Wright); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
| | - David M J Naimark
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (Drs Ferrari Resende, Yarnell, Shah, and Naimark); Sunnybrook Health Sciences Centre, Toronto, Canada (Drs Ferrari Resende and Naimark); Department of Medicine, University of Toronto, Toronto, Canada (Dr Lapinsky and Drs Wright and Naimark)
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Sahin D, Tanacan A, Erol SA, Anuk AT, Ozden Tokalioglu E, Yucel Yetiskin FD, Besimoglu B, Oguz Y, Goncu Ayhan S, Altinboga O, Unlu S, Ozcan N, Keskin HL, Moraloglu Tekin O. Experience of a tertiary pandemic centre on the labour and delivery of 337 pregnant women with COVID-19: a prospective cohort study from Turkey. J OBSTET GYNAECOL 2022; 42:1803-1810. [DOI: 10.1080/01443615.2022.2039907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Dilek Sahin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Atakan Tanacan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Seyit Ahmet Erol
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ali Taner Anuk
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Eda Ozden Tokalioglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Fatma Didem Yucel Yetiskin
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Berhan Besimoglu
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Yuksel Oguz
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Sule Goncu Ayhan
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Orhan Altinboga
- Department of Obstetrics and Gynecology, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Serpil Unlu
- Department of Infectious Diseases, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Namik Ozcan
- Department of Anesthesiology and Reanimation, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Huseyin Levent Keskin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
| | - Ozlem Moraloglu Tekin
- Department of Obstetrics and Gynecology, University of Health Sciences, Turkish Ministry of Health, Ankara City Hospital, Ankara, Turkey
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5
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Shinwell ES, Gurevitz P, Portnov I. Current evidence for prenatal and postnatal corticosteroids in preterm infants. Arch Dis Child Fetal Neonatal Ed 2022; 107:121-125. [PMID: 33658282 DOI: 10.1136/archdischild-2020-319706] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 01/16/2021] [Accepted: 02/17/2021] [Indexed: 01/08/2023]
Abstract
Antenatal corticosteroids undoubtedly save many lives and improve the quality of many others. However, the currently accepted dosage schedule has been in place since 1972, and recent studies have suggested that beneficial effects may be seen with less. Most but not all studies of long-term outcome show no adverse effects. The use of antenatal corticosteroids in women with COVID-19 raises important questions regarding potential risks and benefits. However, currently, most authorities recommend continuing according to published guidelines. With regard to postnatal corticosteroids, alternatives to systemic dexamethasone, the somewhat tainted standard of care, show promise in preventing bronchopulmonary dysplasia without adverse effects. Systemic hydrocortisone and inhaled corticosteroids are of note. The mixture of surfactant and corticosteroids deserves particular attention in the coming years.
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Affiliation(s)
- Eric S Shinwell
- Neonatology, Ziv Medical Center, Tzfat, Israel .,Azrieli Faculty of Medicine, Bar-Ilan University, Tzfat, Israel
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6
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Samawi H, Chen DG, Ahmed F, Kersey J. Medical diagnostics accuracy measures and cut-point selection: An innovative approach based on relative net benefit. COMMUN STAT-THEOR M 2021. [DOI: 10.1080/03610926.2021.2001016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Hani Samawi
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Ding-Geng Chen
- College of Health Solutions, Arizona State University, Phoenix, Arizona, USA
| | - Ferdous Ahmed
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
| | - Jing Kersey
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA
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7
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Deng Z, Lu D. Letter by Lu et al regarding article "Antenatal corticosteroid therapy: Historical and scientific basis to improve preterm birth management". Eur J Obstet Gynecol Reprod Biol 2021; 268:167. [PMID: 34732306 DOI: 10.1016/j.ejogrb.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/13/2021] [Accepted: 10/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Zhuo Deng
- The First Clinical College, Dalian Medical University, Dalian 116000, PR China; Department of Obstetrics and Gynecology, College of Clinical Medicine, Yangzhou University, Yangzhou 225001, PR China; The Department of Obstetrics and Gynecology, Subei People's Hospital, Yangzhou 225001, PR China.
| | - Dan Lu
- The First Clinical College, Dalian Medical University, Dalian 116000, PR China; Department of Obstetrics and Gynecology, College of Clinical Medicine, Yangzhou University, Yangzhou 225001, PR China; The Department of Obstetrics and Gynecology, Subei People's Hospital, Yangzhou 225001, PR China.
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8
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Lin C, Chu SM, Hsu JF, Hsu CC, Chang YL, Lien R, Cheng SW, Chiang MC. Delivery management of suspected or confirmed COVID-19 positive mothers. Pediatr Neonatol 2021; 62:476-482. [PMID: 34272199 PMCID: PMC8231697 DOI: 10.1016/j.pedneo.2021.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 05/22/2021] [Accepted: 06/01/2021] [Indexed: 10/26/2022] Open
Abstract
The Coronavirus Disease-2019 (COVID-19) pandemic has brought catastrophic impact on the world since the beginning of December 2019. Extra precautionary measures against COVID-19 during and after delivery are pivotal to ensure the safety of the baby and health care workers. Based on current literature, it is recommended that delivery decisions be discussed between obstetricians and neonatologists prior to delivery, and designated negative pressure delivery rooms should be arranged for COVID person under investigation (PUI). During delivery, a minimal number of experienced staff attending delivery should don personal protective equipment (PPE) and follow the neonatal resuscitation program (NRP). Positive pressure ventilation is best used in a negative pressure room if available. At-risk babies should be transported in an isolette, and tested for COVID-19 in a negative pressure room soon after bathing. Skin-to-skin contact and breast milk feed should continue under certain circumstances. Although newborns with COVID-19 infections often present with symptoms that mimic sepsis and one third of affected patients may demand some form of respiratory support, short-term prognoses are favorable and most recover within two weeks of symptoms onset. In this article, we will further elaborate on topics covering timing and mode of delivery, antenatal steroid, vertical transmission, delivery room management, airway management, transport, testing and isolation after birth, skin-to-skin contact, breast milk feeding, clinical features, outcomes, and discharge plans. In addition, we also share our experiences of encountering neonates born of suspected COVID-19 positive mothers.
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Affiliation(s)
- Chih Lin
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Keelung, Taiwan,Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Ming Chu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Division of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jen-Fu Hsu
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Division of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chin-Chieh Hsu
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yao-Lung Chang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Reyin Lien
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Division of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shao-Wen Cheng
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
| | - Ming-Chou Chiang
- Division of Neonatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Division of Respiratory Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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9
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Jirjees F, Saad AK, Al Hano Z, Hatahet T, Al Obaidi H, Dallal Bashi YH. COVID-19 Treatment Guidelines: Do They Really Reflect Best Medical Practices to Manage the Pandemic? Infect Dis Rep 2021; 13:259-284. [PMID: 33915690 PMCID: PMC8167744 DOI: 10.3390/idr13020029] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 02/07/2023] Open
Abstract
SARS-CoV-2 (COVID-19) has been changing the world since December 2019. A comprehensive search into many COVID-19 treatment guidelines was conducted and reported in this article. This is a review paper to probe differences in COVID-19 managing strategies and explore the most common treatment plans among countries. Published guidelines from 23 countries and three references guidelines-until the end of 2020-were included in this article. The majority of COVID-19 treatment options were reported in this review and it includes antiviral drugs, antimalarial drugs, antibiotics, corticosteroids, immunotherapy, anticoagulants, and other pharmacological treatment. The presence of such information from different countries in a single comprehensive review article could help in understanding and speculation of variation in the recommended treatment in each country. This might be related to the cost of medications, the access to the medications, availability of medication that could potentially be useful in managing COVID-19 cases, and the availability/capacity of healthcare facilities. Finally, although there are various treatment groups listed in the published therapeutic guidelines worldwide, unfortunately, there is no evidence for effectiveness of most of these medications in reducing the COVID-19 mortality curve over more than one year of this global pandemic.
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Affiliation(s)
- Feras Jirjees
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates;
| | - Ali K Saad
- College of Medicine and Health Sciences, United Arab Emirates University, Alain, United Arab Emirates
| | - Zahraa Al Hano
- College of Pharmacy, University of Sharjah, Sharjah, United Arab Emirates;
| | - Taher Hatahet
- School of Pharmacy, Queens University Belfast, Belfast, UK; (T.H.); (Y.H.D.B.)
- Queen’s University Belfast Joint College (CQC), China Medical University, No. 77 Puhe Road, Shenyang North New Area, Shenyang 110122, China
| | - Hala Al Obaidi
- Pharmacy Department, City University College of Ajman, Ajman, United Arab Emirates;
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10
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Fiore A, Piscitelli M, Adodo DK, Thomas C, Dessap AM, Bagate F, Folliguet T. Successful Use of Extracorporeal Membrane Oxygenation Postpartum as Rescue Therapy in a Woman With COVID-19. J Cardiothorac Vasc Anesth 2020; 35:2140-2143. [PMID: 32888800 PMCID: PMC7406470 DOI: 10.1053/j.jvca.2020.07.088] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 07/30/2020] [Accepted: 07/31/2020] [Indexed: 01/16/2023]
Abstract
Clinical manifestations of coronavirus disease 2019 in pregnant women, in contrast to previous outbreaks, seem to be similar to those of nonpregnant women. During severe acute respiratory syndrome (SARS), SARS influenza A, and Middle East respiratory syndrome outbreaks, an increased severity of disease among pregnant women was observed. In some pregnant women, respiratory failure can occur and progress quickly to acute respiratory distress syndrome requiring extracorporeal membrane oxygenation (ECMO) as a rescue therapy. Despite a lack of current guidelines on the use of ECMO in pregnant or postpartum women, this support therapy is an effective salvage therapy for patients with cardiac and/or respiratory failure, and is associated with favorable maternal and fetal outcomes. Herein, the authors report a case of severe COVID-19 disease in a pregnant patient after urgent cesarean delivery, who was treated successfully with ECMO during the postpartum. Extracorporeal membrane oxygenation should be considered early when conventional therapy is ineffective, and it is essential to refer to ECMO expert centers.
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Affiliation(s)
- Antonio Fiore
- Department of Cardiac Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France.
| | - Mariantonietta Piscitelli
- Department of Cardiac Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Didier K Adodo
- Department of Cardiac Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Charrier Thomas
- Department of Cardiac Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
| | - Armand Mekontso Dessap
- Medical Intensive Care Unit, DHU A-TVB, Henri-Mondor University Hospital, Assistance Publique -Hôpitaux de Paris (AP-HP), Créteil, France
| | - François Bagate
- Medical Intensive Care Unit, DHU A-TVB, Henri-Mondor University Hospital, Assistance Publique -Hôpitaux de Paris (AP-HP), Créteil, France
| | - Thierry Folliguet
- Department of Cardiac Surgery, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, Créteil, France
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