Guidelines By AIIMs For Treatment Of Severe Covid-19 Patients

By Vaibhavi Dahake

26 April 2021

India has reported over 3.5 Lakh new daily COVID-19 cases as we continues to struggle under the second and a much more alarming wave of the pandemic. We have seen more and more cases with the new mutant strain virus with increasing number of Severe category patients..

A severe category patient is someone whose respiratory rate is more than 30 per minute and faces breathlessness, while the oxygen saturation level falls below 90% on room air. Here's a clinical guidelines by AIIM's you should know about.

Here’s what should be done for respiratory support of Severe Case: – Consider use of NIV in patients with increasing oxygen requirement, if work of breathing is low. – Consider use of HFNC in patients with increasing oxygen requirement.

– Intubation should be prioritised in patients with high work of breathing /if NIV is not tolerated. – Use conventional ARDSnet protocol for ventilator management.

Anti-inflammatory therapy –According to guidelines, Injection Methylprednisolone 1 to 2 mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

Anticoagulation or to prevent Blood Clotting – Weight-based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight – Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD). – There should be no contraindication or high risk of bleeding.

Supportive measures for severe Patients – Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness). – If sepsis/septic shock: manage as per existing protocol and local antibiogram.

Here’s how you should continue to monitor the patient -Serial CXR; Conduct a HRCT chest scan only if the condition worsens

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