FAQs: What Are New Clinical Protocols for COVID-19 ICU Treatment?

Here are some frequently asked questions answered by specialists at AIIMS e-ICUs.

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FAQ
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Workers prepare an OT (Operation Theatre) at an ICU ward, specially for COVID-19 patients, during its inauguration in Bengaluru, on Wednesday, 26 August, 2020. Image used for representation.
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The Ministry of Health and Family Welfare has released a new set of guidelines for the management for COVID-19 ICU patients. Here are some frequently asked questions answered by specialists at AIIMS e-ICUs.

You can read the full FAQs here.

Should we use HCQ (Hydroxychloroquine) as prophylaxis in health care workers?

HCQ has been advised as prophylaxis in health care workers and high-risk contacts (without contraindications). It can be administered along with proper employment of PPE and other such infection control measures.

Can Ivermectin be used for COVID-19 patients?

Ivermectin has been identified as a potent inhibitor of SARS-CoV-2 replication in vitro. However, the dose required to recreate this effect in vivo far exceeds the standard dose. Hence, it is not recommended in the national guidelines as of now, but can be administered in patients for whom HCQ is contraindicated.

Should we continue using anticoagulation post-discharge?

There have been no delayed post-COVID thrombotic complications so far. Since the prothrombotic state accompanies the viremic and inflammatory phase, once the patient has been discharged, the risk of thrombotic complications also reduces.  Hence, anti-coagulation at discharge in routine COVID patients is not advised unless suggested for other reasons like DVT, prosthetic valve etc.

What should be done about sudden deaths due to COVID-19?

Sudden deaths have been reported both at presentation to emergency department (ED) as well as in hospital. Possible reasons for the same include a sudden cardiac event/ ACS, preceding silent hypoxia that went unnoticed, or due to athrombotic complication such as pulmonary thromboembolism.

Patients with significant risk factors, who are more susceptible to developing a more severe COVID-19 infection, or those with prior comorbid conditions such as CAD orchronic lung disease, should be strictly monitored for their saturation. They should not be permitted to move unattended. Anticoagulant should be used in all at-risk patients who do not have any risk of bleeding.

Methyl prednisolone vs dexamethasone – which is better?

Corticosteroids are currently suggested for moderate to severe cases of COVID-19. Recovery trials have used dexamethasone. However, both IV dexamethasone or methylprednisolone can be used depending on the availability.

What is the function of Tocilizumab?

Tocilizumab has been approved by DCGI on a compassionate ground in view of the ongoing pandemic. However, it is an experimental therapy with a limited role. It should be used only in patients with cytokine syndrome once the prospect of active infections is ruled out.

What is the role of plasma therapy?

Convalescent plasma obtained from ABO blood type matched donors with high neutralising titers may be given to patients at risk of developing severe infection at early stages of the disease. However, it is an experimental therapy and should be used with caution.

What is the role of Favipiravir?

Studies have administered Favipiravir mainly for mild or asymptomatic COVID cases, claiming to prevent progression. However, the majority of this cohort recovers with supportive care and monitoring and usually requires no specific therapy. The evidence for the use of Favipiravir is weak and it is currently not recommended in national guidelines.

What is the role of antifibrotics in prevention of lung fibrosis?

There is no evidence to support the use of antifibrotic agents like pirfenidone in prevention of COVID-19 related fibrosis and hence they should not be used.

How to prevent depression in patient of COVID-19?

Depression is increasingly common in patients with COVID-19. This may be because of numerous reasons, such as staying in isolation, anxiety about the disease, and social stigma, among others. Such patients need to be treated with empathy and professional psychological counselling should be provided.

Should we give Remdesivir/TCZ to a highly suspected patient who is COVID-negative on all reports?

Remdesivir/TCZ are experimental therapies, approved by DCGI in view of the ongoing pandemic. Therefore, they should not be used as an empirical therapy for suspected cases. These agents should be administered only in proven COVID patients, where clinically suggested.

Should parents be allowed to stay with COVID-19 positive children?

Parents can be permitted to stay with their children after explaining the risk entailed and taking consent for the same.

(This article was first published on FIT and has been republished with permission.)

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