COVID-19 patient Severe disease
Any one of:
- Respiratory rate > 30 /min
- SpO2 < 90% on room air
Respiratory support
• Consider use of NIV (Helmet or face mask interface depending on availability)/HFNC in patients with increasing oxygen requirement, if work of breathing is LOW
• Intubation should be prioritized in patients with high work of breathing /if NIV is not tolerated
• Use conventional ARDSnet protocol for ventilatory management
Anti-inflammatory or immunomodulatory therapy
• Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone – 0.2 to 0.4 mg/kg per day) usually for a duration 5 to 10 days
Anticoagulation
• Weight based intermediate dose prophylactic UFH or LMWH (e.g., Enoxaparin 0.5mg/kg per dose SC BD)
Supportive measures
• Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness)
• If sepsis/septic shock: manage as per existing protocol and local antibiogram
Monitoring
• Serial CXR; HRCT chest to be done ONLY if deteriorating
• Lab monitoring: CRP and D-dimer 24-48 hourly; CBC, KFT, LFT daily; IL-6 to be done if deteriorating (subject to availability)