Updated guidance on the management of COVID-19 by International Task Force
Recently a newly formed Task Force,co-ordinated by the American Thoracic Society and European Respiratory Society, has addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities. The recommendations have been published in the European Respiratory Review.
As new knowledge continues to be published, providing an increasing evidentiary basis for sound clinical care in the current COVID situation, the Task Force updated its prior guidance on the pharmacological management of acute COVID-19, including remdesivir, hydroxychloroquine (HCQ) and dexamethasone.
The International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. The updated suggestions were made by the results of large observational studies and the preliminary release of information from multiple randomised controlled trials.
Two notable randomised trials informed the Task Force.The first was the Adaptive COVID-19 Treatment Trial (ACTT), a multi-centre, double-blind, placebo-controlled randomised trial of 1063 COVID-19 patients that released its results early after an interim analysis. The second was a randomised, double-blind, placebo-controlled multi-centre trial of 236 COVID-19 patients from Wuhan, China
Taking cue from the results of these studies, the task force team made some important updated recommendations in various situations. The list has been elaborated below.
On Pharmacotherapy of acute COVID-19-
1) For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving extracorporeal membrane oxygenation (ECMO), the Task Force suggests remdesivir
2) For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests remdesivir.
3) For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving ECMO, the Task Force suggests not using HCQ except within a clinical trial.
4) For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests not using HCQ except within a clinical trial.
5) For hospitalised patients with COVID-19 pneumonia who require supplemental oxygen but are not mechanically ventilated or receiving ECMO, the Task Force suggests dexamethasone.
6) For hospitalised patients with COVID-19 pneumonia who are mechanically ventilated or receiving ECMO, the Task Force suggests dexamethasone.
For adults who were hospitalised with COVID-19 pneumonia-
- Makes no suggestion for or against routine post-hospital pulmonary function testing (PFT) within 30–60 days to establish a new baseline.
- Makes no suggestion for or against routine chest computed tomography (CT) within 30–60 days to establish a new baseline.
- Makes no suggestion for or against routine transthoracic echocardiography (TTE) within 30–60 days to establish a new baseline
- Makes no suggestion for or against routine cardiopulmonary exercise testing (CPET) within 30–60 days to establish a new baseline.
For the Follow-up of COVID-19 survivors in post-hospital anticoagulant management
I. For adults who were hospitalised with COVID-19 pneumonia, the Task Force makes no suggestion for or against continuing prophylactic-dose anticoagulant therapy as outpatients until their D-dimer normalises to reduce the risk of venous thromboembolism.
II. For adults who were hospitalised with COVID-19 pneumonia and had confirmed venous thromboembolism, the Task Force suggests therapeutic-dose anticoagulant therapy for 3 months to reduce the risk of recurrent venous thromboembolism.
For the Follow-up of COVID-19 survivors: post-hospital infection control-
I. For adults who were hospitalised with COVID-19 pneumonia, the Task Force makes no suggestion for or against routine post-hospital serological testing to assess their immune response to the infection.
II. For adults who were hospitalised with COVID-19 pneumonia, the Task Force makes no suggestion for or against allowing patients whose serological tests demonstrate antibodies against SARS-CoV-2 to attend in-person medical appointments without screening for active infection.
III. For the household contacts of adults who were hospitalised with COVID-19 pneumonia, the Task Force makes no suggestion for or against routine serological testing to determine if they had mild or asymptomatic infection.
For the Follow-up of COVID-19 survivors: post-hospital physical and mental rehabilitation
I. Makes no suggestion for or against routine referral to a dedicated multidisciplinary clinic specialising in post-intensive care syndrome (PICS).
II. Makes no suggestion for or against routine referral to a dedicated pulmonary rehabilitation programme regardless of the presence or severity of lung function abnormalities.
III. Makes no suggestion for or against routine post-hospital screening for cognitive impairment within 30–60 days.
IV. Makes no suggestion for or against routine post-hospital screening for depression, anxiety, and post-traumatic stress disorder (PTSD) within 30–60 days.
V. Makes no suggestion for or against routine post-hospital referral for mental health counselling within 30–60 days.
For the full article ,follow the link: 10.1183/16000617.0287-2020
Primary source: European Respiratory Review
