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