New Delhi: Given the dynamic Covid-19 situation in the country, the Ministry of Health and Family Welfare has released revised clinical guidelines for the management of adult Covid-19 patients.
COVID-19 National Task Force under Ministry of Health and Family Welfare releases revised clinical guidance for the management of adult COVID-19 patients pic.twitter.com/x4R6ZntVnz
– ANI (@ANI) January 17, 2022
Mild Covid Disease
According to the revised guidelines, Covid-19 patients experiencing moderate symptoms without shortness of breath or hypoxia must be isolated at home.
Such patients have also been recommended to keep a safe physical distance, practise good hand hygiene, and wear masks indoors.
Mild Covid patients should seek medical assistance only if they have trouble breathing, a high temperature, or a severe cough that lasts more than 5 days.
Moderate Covid Disease
People with moderate Covid symptoms, such as dyspnea or SP02 levels ranging between 90 and 93%, might be admitted to the clinical ward to receive Covid therapy.
Such patients, according to the revised recommendations, should be provided oxygen assistance.
All patients who require supplemental oxygen treatment should be urged to pronate while awake (sequential position changes every 2 hours).
Anti-inflammatory or immunomodulatory medication are two more options. There should be no contraindications or excessive bleeding risk.
If the patient’s condition worsens, clinical (breathing work, hemodynamic instability, change in oxygen demand) and lab tests (CRP and D-dimer 48 to 72 hourly; CBC, KFT, LFT 24 to 48 hourly; IL-6 levels) will be performed.
Severe Covid Disease
Patients with Covid-19 who have SP02 levels less than 90% should be admitted to the ICU.
Such patients should be placed on mechanical ventilation. If the work of breathing is low, NIV (Helmet or face mask interface depending on availability) should be employed in patients with rising oxygen demand. In patients with rising oxygen demand, HFNC should be employed.
Intubation should be emphasised in individuals who require a lot of help breathing or if NIV is not tolerated. Other therapies include anti-inflammatory medication (inj Methylprednisolone 1 to 2mg/kg IV in two split doses or an equivalent dosage of dexamethasone) for 5 to 10 days.
If the patient’s condition worsens, clinical (breathing work, hemodynamic instability, change in oxygen need) and lab tests (CRP and D-dimer 24-48 hourly; CBC, KFT, LFT 24 to 48 hourly; IL-6 levels) will be performed.
Following clinical improvement, a patient should be released in accordance with amended discharge criteria.
Remdesivir (EUA) May Be Considered Only In Patients With:
Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN)
No renal or hepatic dysfunction
Who are within 10 days of onset of symptoms
Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.
Not to be used in patients who are not on oxygen support or in-home settings
Tocilizumab (Off-Label) May Be Considered Only In Patients With:
Presence of severe disease (preferably within 24 to 48 hours of the onset of severe disease/ICU admission).
Significantly raised inflammatory markers (CRP &/or IL-6).
Not improving despite the use of steroids.
No active bacterial/fungal/tubercular infection.
Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1 hour.
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