ANZICS COVID-19 GUIDELINES

The last eighteen months have provided the critical care health community with enormous challenges. ANZICS has continued to be proactive in delivering solutions, scientific information and support to health care providers, with the sole intention of maximising patient outcomes and provider welfare. We have been innovative, informative and provided an honest and measured response to all agencies. It is therefore, with an enormous sense of achievement that we present our fourth version of the ANZICS COVID-19 Guidelines. The guidelines have proved to be an invaluable resource for those critical care health care workers charged with preparing, training and delivering care for patients potentially infected or infected with COVID-19.

The team have worked tirelessly to generate practical, reliable and informative guidelines based on the best evidence available. Since our third iteration of the guidelines, much has been learnt from the Australian, New Zealand and international experience. A range of ANZICS COVID-19 publications and data indicate our clinical outcomes are extremely gratifying with excellent results. We will continue to be vigilant, learn and research in order to provide the highest standard of care to Australians and New Zealanders as we learn to live and cope with COVID.

Evidence based best practice guidelines remain an important strategy designed to keep clinicians current in a dynamic critical care environment, where resources are inevitably finite. These guidelines represent many dedicated hours of work by the ANZICS COVID-19 Working Group and are presented in a concise and easily accessible format. The critical care community are immensely grateful for the effort and dedication demonstrated by a remarkably talented, motivated group of professionals.

The fourth edition includes revised content on ‘Planning for a Pandemic’ and ‘Staff Safety’, providing valuable information to guide both clinicians and health administrators in a challenging and dynamic environment. The operational ‘risk matrix’ on escalating phases of the pandemic has been modified to align with other reputable public health documents. In accordance with our whole-of-health systems approach, there are expanded sections on paediatric considerations, patient transport, metrics and data monitoring, and engineering/ventilation concerns. We thank our Allied Health colleagues for their valuable contribution to the new Post ICU Care section, which delivers sound recommendations for patients with “long COVID-19” following discharge from ICU. One of the very great challenges and tragedies of caring for COVID-19 patients has been the restrictions placed on loved ones. These guidelines provide updated useful strategies for family engagement and visitation, as well as an extensively updated section on staff wellbeing.

The ANZICS Guidelines are not proscriptive, but rather a valuable resource to be integrated with local recommendations. We can be incredibly proud of the collaborative and pragmatic stance our Society has embraced, in order to deliver meaningful guidance to the critical care community.

It is my sincere belief that these guidelines will decrease both morbidity and mortality. We in ANZICS will continue to strive to deliver the best possible tools to support critical care in our effort to defeat COVID-19. We acknowledge, with gratitude, the efforts of all and trust that you can safely fulfil your privileged duty to care for patients in challenging times. Thank you to our critical care family.

Anthony Holley
President, ANZICS

The COVID-19 viral pandemic has presented an unprecedented challenge to intensive care services around the world. In Australia and New Zealand, we are fortunate to have world-class intensive care services, with a highly trained and professional workforce who are ready and able to serve their communities at this time. This document aims to provide a series of recommendations and suggestions to ensure continued high-quality clinical care in the setting of a pandemic. To develop this guideline, we have drawn on the increasing evidence from around the world on how to treat patients with COVID-19 and learnings from the current pandemic experience as well as the contemporary infection control literature for Intensive Care. This is the fourth version of the ANZICS COVID-19 guideline. The most up to date document and all previous iterations can be found under Current and Previous Versions below.

The situation in Australia and New Zealand remains fluid with a substantial fourth wave of COVID-19 infections and the concurrent implementation of significant public health measures. The recurrence of significant numbers of COVID-19 cases have demonstrated the need to prepare our hospitals, intensive care units and staff. The ANZICS community strongly supports all robust public health measures to minimise load on limited ICU capacity for all patients, not just those with COVID-19; and to maintain the health, wellbeing, and sustainability of the intensive care workforce. In 2021, the outcomes for critically ill COVID-19 patients in Australia and New Zealand have been amongst the best in the world. This is due to a number of factors, in particular that our health services have not been overwhelmed and that intensive care units have been able to provide high quality critical care. The costs of such measures are not insignificant with impact on mental health, access to medical care, access and uptake of investigative services, elective surgery and for many, a major economic burden. Variants of concern (in particular the delta variant) have contributed to subsequent waves and appear to have broadened the at-risk groups particularly the paediatric population. Efficient and practical operational solutions must be developed to maintain the health workforce, particularly in critical care areas including surveillance programs for those caring for suspected or proven COVID-19 patients.

The ANZICS community supports an efficient vaccination program, supported by education, communication and advocacy, targeting a population vaccination target of greater than 80% and reduce the need for public health measures to meet the health system challenges of further waves. ANZICS also supports mandatory vaccination for health care workers.

The following additions have been included in Version 4 of the ANZICS COVID-19 Guidelines:

1. An expanded section on data monitoring and management
2. A section on “Post-ICU Care” with particular relevance for patients with long COVID-19 following ICU admission
3. Extensively updated section on staff wellbeing and patient transport
4. Revised “Planning for a Pandemic” and “Staff Safety” sections taking into account vaccination and experience with the delta variant, both in Australia and overseas.

Section 1: Planning for a COVID-19 Pandemic

Section 2: Providing a Safe Working Environment. Staff Protection and Sustainability

Section 3: Identification and Treatment of COVID-19

Appendix 1: Levels of Critical Care Capability in Remote, Rural and Regional Areas

Appendix 2: Checklist for ANZICS “Planning for a Pandemic” guideline

Appendix 3: Checklist for “Staff Safety and Sustainability” guideline

Appendix 4: CDNA risk matrix for COVID exposure

Appendix 5: Useful patient and family information leaflets and resources for post ICU care

Appendix 6: Resources for Staff Wellbeing section

Appendix 7: Data Management Summary and Recommendations

• General Bibliography
• Long Term Impairment
• Staff Wellbeing
• Metrics and Data Monitoring

• ANZICS – COVID-19 Guidelines Version 4
• ANZICS – COVID-19 Guidelines Version 3
• ANZICS – COVID-19 Guidelines Version 2 
• ANZICS – COVID-19 Guidelines Version 1