AIIMS Releases new Clinical Guidance for Management of Covid-19
New Delhi: The premier All India Institute of Medical Sciences (AIIMS), Delhi has released Clinical Guidance for Management of Covid-19 (Version 2.1).The guidelines specify the management protocol for COVID patients with mild, moderate and severe disease.1. Mild diseaseUpper respiratory tract symptoms (&/or fever) WITHOUT shortness of breath or hypoxiaHome Isolation✓ Contact &...
New Delhi: The premier All India Institute of Medical Sciences (AIIMS), Delhi has released Clinical Guidance for Management of Covid-19 (Version 2.1).
The guidelines specify the management protocol for COVID patients with mild, moderate and severe disease.
1. Mild disease
Upper respiratory tract symptoms (&/or fever) WITHOUT shortness of breath or hypoxia
Home Isolation
✓ Contact & droplet precautions; strict hand hygiene
✓ Symptomatic management(hydration, anti- pyretics, anti-tussive)
✓ Stay in contact with the treating physician
• Seek immediate medical attention if:
o Difficulty in breathing/RR >= 24/min/ SpO2<94%
o High-grade fever/ severe cough particularly beyond 5 days of symptoms onset
o A low threshold should be kept for those with any of the high-risk features*
➢ Tab Ivermectin (200 mcg/kg once a day for 3 to 5 days) to be considered.
(Avoid in pregnant/ lactating).
➢ If fever is not controlled with a maximum dose of Tab. Paracetamol 650 mg QID, may consider the use of NSAID like Tab. Naproxen 250 mg BD
➢ Inhalational Budesonide (given via DPI, MDI with Spacer at a dose of 800 mcg BD for 5 to 7 days to be given if symptoms(fever and/ or cough) are persistent beyond 5 days of disease onset.
➢ Systemic Steroids NOT indicated in mild disease; however, may be considered in cases with high-grade fever and worsening cough beyond 7 days only in consultation with the treating physician for a duration of 3-5 days.
Tab Dexamethasone 0.1 to 0.2 mg /kg OD or
Tab Methylprednisolone 0.5-1 mg/kg in 2 divided doses
2. Moderate disease
Any one of:
1. Respiratory rate >=24/min
2. SpO2 < =93% 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 should be encouraged in all patients who are requiring supplemental oxygen therapy( sequential position changes every 1-2 hours)
Anti-inflammatory or immunomodulatory therapy
➢ Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided doses ( or an equivalent dose of dexamethasone -0.1 to 0.2 mg/ kg per day) usually for a duration of 5 to 10 days.
➢ Patients may be initiated or switched to the oral route if stable and/ or improving
Anticoagulation
➢Conventional dose prophylactic UFH or LMWH (weight-based e.g., enoxaparin 0.5mg/kg per day SC OD)
Monitoring
➢ Clinical Monitoring: Work of breathing, Hemodynamic instability, Change in oxygen requirement
➢ Serial CXR, HRCT Chest to be done only if there is worsening.
➢ Lab monitoring: CRP, D-dimer every 48 to 72 hrly; CBC, KFT, LFT 24 to 48 hrly; IL-6 levels to be done if deteriorating (subject to availability)
3. Severe disease
Any one of:
1. Respiratory rate > 30 /min
2. SpO2 < 90% on room air
ADMIT IN ICU
Respiratory support
• Consider the use of NIV/(Helmet or face mask interface depending on availability)/ HFNC in patients with increasing oxygen requirement, if work of breathing is LOW
• Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated
• Use Conventional ARDSnet protocol for the ventilatory management
Anti-inflammatory or immunomodulatory therapy
• Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses( or an equivalent dose of dexamethasone - 0.2 to 0.4 mg/kg per day) usually for duration 5 to 10 days.
Anticoagulation
• Weight based Intermediate dose prophylactic UFH or LMWH (e.g., Enoxaparin 0.5mg/kg per dose SC BD)
Supportive measures
• Maintain euvolemia(if available, use dynamic measures for assessing fluid responsiveness)
• If sepsis/septic shock: manage as per existing protocol and local antibiogram
Monitoring
➢ Serial CXR, HRCT Chest to be done ONLY if deteriorating
➢ Lab monitoring: CRP and D-dimer 24-48 hourly; CBC, KFT, LFT daily; IL-6 levels to be done if deteriorating (subject to availability)
After clinical Improvement discharge as per revised discharge criteria
Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement/treatment or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2024 Minerva Medical Treatment Pvt Ltd