Reference recommendation | Population | WHO1 | ANZ7 | BEL8 | CAN9 | NHC10 | NIH11 | SSC12 | ICM13 | UTD14 | |
#1 | Initial oxygen therapy | Patients with SARI and respiratory distress, hypoxaemia or shock | Target SpO2 ≥94% | N/A | N/A | Target SpO2 ≥94% | N/A | N/A | N/A | N/A | N/A |
#2 | Maintenance oxygen therapy | Patients stabilised after initial oxygen therapy | Target SpO2 >90% | N/A | N/A | Target SpO2 90–96% | N/A | Target SpO2 92–96% | Target SpO2 92–96% | Target SpO2 92–96% | Target SpO2 90–96% |
#3 | Empiric antimicrobials | Patients with SARI and sepsis | Empiric antimicrobials within 1 hour of the initial assessment | Empiric antimicrobials within 1 hour of the initial assessment | N/A | Empiric antimicrobials within 1 hour of the initial assessment | Blind or inappropriate use of antimicrobials should be avoided | N/A | Empiric antimicrobials in mechanically ventilated patients with respiratory failure | N/A | N/A |
#4 | Fluid management | Patients with SARI | Conservative strategy | Conservative strategy | N/A | Conservative strategy | N/A | N/A | Conservative strategy | N/A | Conservative strategy |
#5 | Neuromuscular blockade | Patients with moderate-severe ARDS (PaO2/FiO2<150) | No routine neuromuscular blockade use by continuous infusion | N/A | N/A | No routine neuromuscular blockade use by continuous infusion | N/A | Continuous NMBA infusion to facilitate protective lung ventilation | No routine neuromuscular blockade use by continuous infusion | N/A | No routine neuromuscular blockade use by continuous infusion |
#6 | Thromboprophylaxis | Patients with SARI | Pharmacological prophylaxis if without contraindications | No pharmacological prophylaxis | N/A | Pharmacological prophylaxis if without contraindications | Pharmacological prophylaxis if without contraindications | N/A | N/A | N/A | Pharmacological prophylaxis if without contraindications |
#7 | Stress ulcer prevention | Patients with SARI | Administer histamine-2 receptor blockers or proton pump inhibitors in patients with risk factors for GI bleeding | N/A | N/A | Administer histamine-2 receptor blockers or proton pump inhibitors in patients with risk factors for GI bleeding | N/A | N/A | N/A | N/A | N/A |
#8 | Resuscitation for septic shock (1) | Patients with septic shock | Administration of crystalloid fluid | N/A | N/A | Administration of crystalloid fluid | N/A | Administration of crystalloid fluid | Administration of crystalloid fluid | N/A | N/A |
#9 | Resuscitation for septic shock (2) | Patients with septic shock | Use of hypotonic crystalloids, starches or gelatins is not allowed | N/A | N/A | Use of hypotonic crystalloids, starches or gelatins is not allowed | N/A | Use of hypotonic crystalloids, starches or gelatins is not allowed | Use of hypotonic crystalloids, starches or gelatins is not allowed | N/A | N/A |
#10 | Vasopressor for septic shock (1) | Patients in whom septic shock persists during or after fluid resuscitation | Norepinephrine is considered the first-line treatment | N/A | N/A | Norepinephrine is considered the first-line treatment | N/A | Norepinephrine is considered the first-line treatment | Norepinephrine is considered the first-line treatment | N/A | N/A |
#11 | Vasopressor for septic shock (2) | Patients who received vasopressor for septic shock | Target MAP ≥65 mmHg | N/A | N/A | Target MAP ≥60 mmHg | N/A | N/A | Target MAP 60–65 mmHg | N/A | N/A |
#12 | Inotrope for septic shock | Patients in whom poor perfusion and cardiac dysfunction persist despite achieving MAP target | An inotrope is considered | N/A | N/A | An inotrope is considered | N/A | An inotrope is considered | An inotrope is considered | N/A | N/A |
#13 | Systemic corticosteroids | Patients with SARI | No routine systemic corticosteroids use | No routine systemic corticosteroids use | No routine systemic corticosteroids use | No routine systemic corticosteroids use | Systemic corticosteroids in patients with progressive deterioration of oxygenation indicators, rapid progress in imaging and excessive activation of the body's inflammatory response | Low-dose corticosteroid therapy in patients with refractory shock | Systemic corticosteroids In mechanically ventilated patients with ARDS | No routine systemic corticosteroids use | Low-dose corticosteroid therapy for ICU patients who require oxygen supplementation and selected patients with refractory shock |
ANZ, Australian and New Zealand Intensive Care Society; ARDS, acute respiratory distress syndrome; BEL, Belgium; CAN, Canada; FiO2, percentage of inspired oxygen; GI, gastrointestinal; ICM, a collaboration of Faculty of Intensive Care Medicine, Intensive Care Society, Association of Anaesthetists and Royal College of Anaesthetists of the UK; ICU, intensive care unit; MAP, mean arterial pressure; N/A, no concrete recommendation available; NHC, National Health Commission of China; NIH, US National Institutes of Health; NMBA, neuromuscular blocking agent; PaO2, partial pressure of arterial oxygen; SARI, severe acute respiratory infection; SpO2, oxygen saturation; SSC, Surviving Sepsis Campaign; UTD, UpToDate (UTD) point-of-care resources; WHO, World Health Organization.