New guidelines by AIIMS for treating COVID-19

AIIMS New Delhi has issued new guidelines to treat COVID-19 cases based on the severity of the case i.e mild, moderate and severe cases.

Mild Cases

Identification: Upper respiratory tract symptoms and / or fever without shortness of breath

Recommendation:  Home isolation and care

Must Do's:  - Social distancing, mask indoors, sanitizing. - Stay in contact with treating physician. - Monitor temperature and oxygen saturation

Seek Medical Attention if: - Difficulty in breathing - High fever/ severe cough for more than five days - Keep low threshold for high-risk features

Moderate Cases

Identification: The patient's respiratory rate is more than 24/min and there's breathlessness.

Recommendation:  Admit in Ward

Oxygen Support:

- Target SpO2: 92-96% - Non-breathing mask for oxygenation - Position change for patient requiring supplemental oxygen therapy

Anti-inflammatory or immunomodulatory therapy

Injection Methylprednisolone 0.5 to 1 mg in 2 doses

Anticoagulation

Conventional dose of prophylactic unfractionated heparin or Low Molecular Weight heparin

Monitoring

Work of Breathing, hemodynamic instability, change in oxygen requirement

Serial CXR; HRCT chest only if there is worsening

Lab Monitoring: CRP and D-dimer 48 to 72 hourly

Severe Case

Identification: Respiratory rate more than 30/ min or breathlessness or SpO2

Recommendation:  Admit in ICU

Respiratory support:

Use NIV if work of breathing is low

Use HFNC with increasing oxygen requirement

Intubation if NIV is not tolerated

Use conventional ARDSnet protocol for ventilator management

- Injection Methylprednisolone 1 to 2 mg in 2 doses - Weight based prophylactic unfractionated heparin - No contraindication

Anti-inflammatory & Anticoagulation

- Maintain Euvolemia  - Manage sepsis/septic shock per existing protocol - Monitor Serial CXR and HRCT if worsening

Supportive Measures:

Used in rare cases and emergency use authorization - moderate to severe disease - No renal or hepatic dysfunction - 10 days of onset of symptoms - 200mg on day 1 and 100mg for next 4 days

Remedesivir

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