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

• India, on Friday, has reported over 3 lakh new COVID-19 cases for the second consecutive day.
• A “severe” category patient is someone whose respiratory rate is more than 30 per minute and faces breathlessness, while the oxygen saturation level falls below 90% on room air.
• If you or a loved one is a “severe” category patient, here’s the clinical guidance issued by the All India Institute of Medical Science (AIIMS) and Indian Council of Medical Research (ICMR).

India has reported over 3 lakh new daily COVID-19 cases, on Friday, for the second consecutive day as the country continues to struggle under the second and a much more alarming wave of the pandemic.

The second wave of the COVID-19 pandemic, with more and more cases of the mutant strain of the virus, has seen a rising number of “severe” category patients. A “severe” category patient is someone whose respiratory rate is more than 30 per minute and faces breathlessness, while the oxygen saturation level falls below 90% on room air.

If you or a loved one is a severe category patient, here’s the clinical guidance combinedly issued by the All India Institute of Medical Science (AIIMS) and Indian Council of Medical Research (ICMR).

A “severe” category patient has to be admitted in the hospital in the intensive care unit. Here’s what should be done for respiratory support:

– For patients whose breathing is low and there’s an increased need for oxygen, consider the use of Non-invasive Ventilation (NIV) (Helmet or face mask interface depending on availability).
– Consider use of HFNC in patients with increasing oxygen requirements. HFNC stands for heat and humidified high flow nasal cannula or as most call it, Hi Flow Nasal Cannula (HFNC), which is basically a respiratory support method.
– As per the guidelines, intubation should be prioritised in patients with high work of breathing, if NIV is not tolerated.
– The new guidance has also recommended the use of conventional ARDSnet protocol for ventilatory management. ARDS stands for Acute Respiratory Distress Syndrome.

Here’s what should be done for anti-inflammatory or immunomodulatory therapy

– Inject Methylprednisolone 1 to 2mg/kg IV in 2 divided doses (or an equivalent dose of dexamethasone) usually for a duration 5 to 10 days.

For anticoagulation or to prevent blood clotting, here’s what should be done

– Weight based intermediate dose prophylactic unfractionated heparin or Low Molecular Weight Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD). There should be no contraindication or high risk of bleeding.

Here are the further supportive measures to be taken for a severe category patient.

– Maintain euvolemia (if available, use dynamic measures for assessing fluid responsiveness). Euvolemia refers to the presence of a proper amount of blood in the body.
– If sepsis/septic shock: manage as per existing protocol and local antibiogram.

Here’s how you should continue to monitor the patient

– Conduct a HRCT chest scan only if the condition worsens.
– Lab monitoring should be done with the following tests - CRP and D-dimer 24-48 hourly; CBC, KFT, LFT daily; IL-6 to be done if deteriorating (subject to availability).

SEE ALSO:
What you can do if you have “mild” COVID-19 symptoms, according to new AIIMS/ICMR guidelines