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The Structured Team-based Optimal Patient-Centered Care for Virus COVID-19 (STOP-VIRUS) Learning Collaborative is a network of intensive care units (ICUs) focused on improving outcomes for patients with COVID-19. This six-month learning collaborative fosters a multisite learning system of U.S. hospitals currently participating in the SCCM Discovery VIRUS Registry. The collaborative focuses on identifying and implementing interventions aimed at reducing marked variations in the outcomes of critically ill patients unexplained by demographics, comorbidities, and severity of illness.
This site provides updates and learning materials for best practices from the collaborative. Applications to join the collaborative are now closed.
Built on the principles of the Mayo Clinic Checklist for Early Recognition and Treatment of Acute Illness and Injury (CERTAIN) program, which has proven effective at improving ICU processes and patient outcomes (Marija, et al. Crit Care Med. 2021;49:e598-e612), STOP-VIRUS provides participating sites opportunities for active learning, dissemination of successful innovations, resources, and peer support to drive quality improvement and change management in their ICU practice settings.
The STOP-VIRUS Curriculum will focus on the following topics :
During weekly Zoom sessions, STOP-VIRUS subject matter experts will deliver state-of-the-art updates for each curriculum topic area. The updates will comprise a summary of currently understood COVID-19 best practices and an update on current literature. Implementation experts will also help nurture the learning community and offer advice on best practices for local site dissemination and implementation efforts. Participating sites will also have the opportunity to continue the dialogue with subject matter experts and program faculty over Twitter via the hashtag #STOPVIRUScollab.
This educational activity was funded in part by a cooperative agreement with the Centers for Disease Control and Prevention (grant number 1 NU50CK000566-01-00). The Centers for Disease Control and Prevention is an agency within the Department of Health and Human Services (HHS). Its contents do not necessarily represent the policy of CDC or HHS, and should not be considered an endorsement by the Federal Government.
Learn more about the many hospitals and teams participating in the collaborative throughout the United States.
Faculty oversee the development and delivery of the STOP-VIRUS Learning Collaborative educational content and materials.
Moderators oversee planning for each curriculum topic block. Moderators interface with presenting sites and subject matter experts, facilitate discussion during weekly video meetings, and continue conversations over Twitter and the Mayo CERTAIN Blackboard platform between meetings.
Subject matter experts deliver state-of-the-science and evidence-based updates to learning collaborative sites. Subject matter experts are distinguished experts on the curriculum topics.
While early reports proposed that acute respiratory distress syndrome (ARDS) due to COVID-19 had unique characteristics, growing evidence suggests that a conventional management approach to the management of respiratory failure is most appropriate.
In addition to the severe hypoxemia often occurring in critically ill patients with COVID-19, the high ventilatory drive and minute ventilation often occurring during the inflammatory phase present significant challenges to conventional management strategies. These challenges typically include:
Because of these challenges, many COVID-19 patients with severe hypoxemia have been managed with high-flow nasal cannula oxygen or noninvasive ventilatory support with or without self-proning to avoid the complications associated with heavy sedation and paralysis that are part of an effective lung-protective strategy following intubation.
The best approaches to noninvasive respiratory support, risk of self-induced lung injury, timing of intubation, and subsequent management of refractory hypoxemic respiratory failure remain controversial.
While noninvasive respiratory support is sufficient for some patients, invasive mechanical ventilation is necessary for many patients with COVID-19 ARDS. Various strategies have been used to optimize the decision and timing of intubation, including the use of formal scoring systems such as the ROX index and the HACOR scale.
Adherence to lung-protective mechanical ventilation and prone positioning remains suboptimal among patients treated with invasive mechanical ventilation. Prone positioning has been demonstrated to be beneficial in nonintubated patients with respiratory failure.
High-Flow Nasal Cannula Oxygen/Noninvasive Ventilation
Awake Prone Positioning
Scoring Systems
Mechanical Ventilation and Prone Positioning in Adults With ARDS
Clinical workload and challenges in care delivery due to shortages of staff, personal protective equipment, and medications during the COVID-19 pandemic have resulted in lower adherence to evidence-based best practices summarized in the ICU Liberation Bundle (A-F). Reduced adherence to the bundle increases several risks, including:
Several studies suggest that strengthening workflow and care processes to ensure the consistent delivery of bundle elements represents the most important modifiable factors for improving the outcomes of critically ill patients with COVID-19.
Best practices identified by institutions participating in the STOP-VIRUS Collaborative include:
Get detailed information and implementation resources associated with the ICU Liberation Bundle
COVID-19 clinical manifestations and management have been a major focus of critical care since the COVID-19 pandemic began. The high volume of information published has resulted in significant challenges in synthesis and implementation. Routine use of treatments that have not been systematically evaluated outside of a clinical trial is not recommended.
Management of critically ill patients with COVID-19 includes:
Bacterial coinfection is uncommon early in the COVID-19 course but should be considered in the setting of clinical relapse or delayed deterioration.
The management of patients with COVID-19 remains a rapidly changing area of investigation. Clinical decisions should be based on up-to-date evidence, including SCCM’s Guidelines on the Management of Critically Ill Adults with Coronavirus Disease 2019 (COVID-19).
The best approach for managing patients with clinical relapse or delayed deterioration, especially in the setting of baseline immune system compromise, remains challenging and controversial.
Checklists have been shown to be effective in decreasing device use rates and should be considered to strengthen ICU workflow processes to combat nosocomial infectious complications.
COVID-19 has been associated with both arterial and venous thrombotic complications, in addition to myocarditis and dysrhythmias. Children with COVID-19 can present with multisystem inflammatory syndrome (MIS-C), which can be life threatening.
Further research is needed on risk factors and more targeted treatment strategies for the cardiovascular complications of COVID-19.
Anticoagulation in COVID-19
MISC-C
The COVID-19 pandemic has created a number of challenges in regard to ethical allocation and patient-centered care. These sessions offer discussion by a wide variety of experts on opportunities for improvement in current triage methods and the importance of patient-centered decision-making to reduce the risk of PICS and minimize healthcare professionals’ moral distress.
The COVID-19 pandemic has underlined the importance of a systematic approach to risk factors and symptoms of burnout among healthcare professionals. An important element of this approach is ongoing efforts to humanize the ICU practice environment and to strengthen relationships between healthcare teams and patients and families to ensure thoughtful, patient-centered decision-making and compassionate end-of-life care.
Acute kidney injury (AKI) is a frequent complication of severe COVID-19. AKI is caused by both direct viral effects and a variety of indirect mechanisms, including intravascular volume management, medication side effects, and the systemic inflammatory response.
Evidence suggests a high rate of long-term renal recovery in COVID-19 survivors, even in the setting of AKI requiring renal replacement therapy.
Renal replacement therapy proved to be an important and limited resource early in the COVID-19 pandemic. Future planning efforts for critical care surge capacity should carefully consider both resource and planning contingencies to meet the needs of both acutely ill and chronically ill patients with kidney disease.
Translating new knowledge, skills, and attitudes into daily ICU practice can be challenging without a systematic approach to quality improvement and implementation. These sessions offer a rapid review of the define, measure, analyze, improve, and control (DMAIC) approach to quality improvement, with immediate application to a variety of quality improvement projects initiated by various participating members of the STOP-VIRUS Collaborative.
