Simplified: AIIMS, ICMR new guidelines for treatment of patients with ‘moderate’ case of COVID-19

• The All India Institute of Medical Sciences (AIIMS) and the Indian Council of Medical Research (ICMR) have issued new guidelines for the treatment of patients with COVID-19.
• Patients with moderate COVID-19, those with respiratory distress, should be put under hospital care until their oxygen saturation levels are at reasonable levels.
• Here is the full list of guidelines by AIIMS and ICMR for moderate COVID-19 patients — simplified.

The All India Institute of Medical Science (AIIMS) and the Indian Council of Medical Research (ICMR) have jointly issued new guidelines for the treatment of COVID-19 patients depending on the severity of a case — mild, moderate, or severe.

And, in the case of moderate infections, India’s apex hospital has recommended that the concerned patient should be admitted into a hospital ward.

How to identify a patient with moderate COVID-19 infection?

According to AIIMS, a patient is classified as having a moderate case of COVID-19 if their respiratory rate is more than 24 breaths per minute and their SpO2 levels — level of oxygen saturation — are between 90% to 93% on room air.

This means the patient is likely to be experiencing breathlessness and needs to be in hospital care.

Recommendations to help with oxygen support

The targeted levels of oxygen saturation, or SpO2, should be between 92% to 96%.

For patients with chronic obstructive pulmonary disease (COPD), the recommended SpO2 level is between 88% to 92%.

AIIMS and ICMR recommend a non-rebreathing face mask for oxygenation.

All patients that require supplemental oxygen therapy should also be awake proning. This is when healthcare workers have patients lie on their stomachs to help with the oxygenation process. According to the guidelines, a patient’s position shoud be changed approximately every two hours.

Anti-inflammatory or immunomodulatory therapy

Immunomodulatory therapy treats diseases targeting the immune system and anti-inflammatory therapy reduces internal swelling.

AIIMS and ICMR recommend giving 0.5 to 1 mg/kg of methylprednisolone, which is usually used to treat severe allergic reactions, divided over two doses — or an equivalent dose of dexamethasone, also used to treat severe allergic reactions — for five to 10 days as injections.

Patients can be switched over to oral medication once they show improvement or are stable.

Anticoagulation

Anticoagulants, also known as blood thinners, are used to prevent blood clots in COVID-19 patients.

The guidelines recommend that moderate COVID-19 cases should be given the conventional dose of prophylactic unfractionated heparin, normally used to treat deep vein thrombosis prophylaxis — blood clots, usually in the legs.

They can also be given Low Molecular Weight Heparin (LMWH), like 0.5 mg/kg of enoxaparin every day.

But anticoagulants should only be used for patients with no contraindication or high risk of bleeding.

Things to monitor with moderate COVID-19 patients

1. Work of breathing — the number of breaths per minute
2. Hemodynamic instability — changes in the flow of blood
3. Change in oxygen requirement — or oxygen saturation
4. Regular X-Rays, HRCT chest scans should only be done if the patient’s condition worsens
5. CRP and D-dimer tests to be conducted every 48 hours to 72 hours.

SEE ALSO:
Here’s the clinical guidance one needs to follow for a 'severe' COVID-19 patient as per AIIMS/ICMR

What you can do if you have 'mild' COVID-19 symptoms, according to new AIIMS/ICMR guidelines