AIIMS releases Interim Clinic Guidance for Management of COVID-19

New Delhi: In the wake of rising COVID- 19 cases in the country, the All India Institute of Medical Sciences (AIIMS) has released the Interim Clinic Guidance for Management of Covid-19.

The guidelines specify the management protocol for COVID patients with mild, moderate and severe disease.

COVID-19 patients with Mild disease

Upper respiratory tract symptoms (&/or fever) WITHOUT shortness of breath or hypoxia 

Home Isolation

✓ Contact & droplet precautions; strict hand hygiene

✓ Symptomatic management

✓ Stay in contact with treating physician

• Seek immediate medical attention if:

o Difficulty in breathing

o High-grade fever/ severe cough

o A low threshold should be kept for patients with high-risk factor*

❖ Peripheral oxygen saturation (by applying a SpO2 probe to fingers) should be monitored at home

❖ Tab Ivermectin (200 mcg/kg once a day for 3 to 5 days) may be considered in patients with highrisk features*

❖ Steroids should NOT be used in patients with only mild disease

COVID-19 patients with Moderate disease

Any one of:

1. Respiratory rate > 24 /min

2. SpO2 < 94% on room air

ADMIT IN WARD

Oxygen Support:

➢ Target SpO2: 92-96% (88-92% in patients with COPD)

➢ Preferred devices for oxygenation: non-rebreathing face mask

➢ Awake proning may be used in those with persistent hypoxia despite use of high flow oxygen (sequential position changes every 1-2 hours)

Antiviral therapy

➢ Inj Remdesivir 200 mg IV on day 1 f/b 100 mg IV daily for 5 days (can be extended upto 10 days in case of progressive disease)

➢ Convalescent plasma (CP) may be considered in carefully selected patients

Anti-inflammatory or immunomodulatory therapy

➢ Inj Methylprednisolone 0.5 to 1 mg/kg (or equivalent dose of dexamethasone) IV in two divided doses for 5 to 10 days

Anticoagulation

➢ Low dose prophylactic UFH or LMWH## (weight based e.g., enoxaparin 0.5mg/kg per day SC)

Monitoring

➢ Clinical Monitoring: Work of breathing, Hemodynamic instability, Change in oxygen requirement

➢ Serial CXR, HRCT Chest (if worsening)

➢ Lab monitoring: CRP, D-dimer & Ferritin 48-72 hrly; CBC, LFT, KFT 24-48 hrly; IL-6 levels to be done if deteriorating (subject to availability)

COVID-19 patients with Severe disease

Any one of:

1. Respiratory rate > 30 /min

2. SpO2 < 90% on room air

ADMIT IN ICU

Respiratory support

• Consider use of HFNC in patients with increasing oxygen requirement if work of breathing is LOW

• A cautious trial of NIV with helmet interface (if available otherwise face mask interface)/CPAP with oro-nasal mask may also be considered

• Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated ^^

• Conventional ARDSnet protocol for ventilatory management

Antiviral therapy

• Antivirals may be considered if duration of illness < 10-14 days

Anti-inflammatory or immunomodulatory therapy

• Inj Methylprednisolone 1 to 2mg/kg in 2 divided doses for 5 to 10 days (or equivalent dose of dexamethasone)

• Tocilizumab may be considered on a case-to-case basis preferably within 24 to 48 hours of progression to severe disease

Anticoagulation

• Intermediate dose prophylactic UFH or LMWH (e.g., Enoxaparin 0.5mg/kg/dose BD SC) ##

Supportive measures

• Maintain euvolemia

• If sepsis/septic shock: manage as per existing protocol and local antibiogram

Monitoring

➢ Serial CXR, HRCT Chest (if worsening)

➢ Lab monitoring: CRP, D-dimer & Ferritin 24-48 hrly; CBC, LFT, KFT daily; IL-6 levels to be done if deteriorating (subject to availability)

After clinical Improvement discharge as per revised discharge criteria