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FAQs On COVID-19 From AIIMS e-ICUs

1. HCQ is recommended as a prophylaxis for HCW and high-risk contacts without contraindications. Ivermectin may be used in patients where HCQ is contraindicated based on in vitro studies, but it is not currently recommended. Anticoagulation is not recommended at discharge unless needed for other reasons like DVT. 2. Sudden deaths in COVID patients have been proposed to be due to cardiac events, silent hypoxia, or thrombotic complications like PE. At-risk patients should be closely monitored and not left unattended. 3. Dexamethasone or methylprednisolone may be used based on availability as corticosteroids

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80 views

FAQs On COVID-19 From AIIMS e-ICUs

1. HCQ is recommended as a prophylaxis for HCW and high-risk contacts without contraindications. Ivermectin may be used in patients where HCQ is contraindicated based on in vitro studies, but it is not currently recommended. Anticoagulation is not recommended at discharge unless needed for other reasons like DVT. 2. Sudden deaths in COVID patients have been proposed to be due to cardiac events, silent hypoxia, or thrombotic complications like PE. At-risk patients should be closely monitored and not left unattended. 3. Dexamethasone or methylprednisolone may be used based on availability as corticosteroids

Uploaded by

rakeshambasana
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© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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All India Institute of Medical Sciences, New Delhi

National e-ICU on COVID-19 management

FAQs on COVID-19 from AIIMS e-ICUs

1. Should we use HCQ as prophylaxis in health care workers (HCW)?


Hydroxychloroquine (HCQ) has been advised as prophylaxis in HCW and high-risk
contacts without contraindications. It can be used along with proper use of PPE and
other infection control practices to protect from COVID 19.

2. Can Ivermectin be used for COVID patients?


Ivermectin has been found to be a potent inhibitor of SARS CoV2 replication in vitro,
but the doses required to achieve this effect in vivo far exceeds the usual dose. It is
currently not recommended in the national guidelines but can be used in patients in
whom HCQ is contraindicated.

3. Should we continue using anticoagulation post discharge?


In our experience, there have been no delayed post-COVID thrombotic complications.
Since the prothrombotic state parallels the viremic and inflammatory phase, once
the patient has been discharged, the thrombotic risk also decreases. So, we don’t
recommend anti-coagulation at discharge in routine COVID patients unless indicated
for other reasons like DVT, prosthetic valve etc.

4. Sudden deaths in COVID-19


Sudden deaths have been reported both at presentation to emergency department
(ED) as well as in hospital. Reasons that have been proposed include a sudden
cardiac event/ ACS, preceding silent hypoxia that went unnoticed or due to a
thrombotic complication such as pulmonary thromboembolism. Patients with risk
factors to develop severe COVID or with prior comorbid conditions such as CAD or
chronic lung disease should be strictly monitored for their saturation. They should
not be allowed to move unattended. Anticoagulant should be used in all at-risk
patients who do not have any risk factors of bleeding.
5. Methyl prednisolone vs dexamethasone
Corticosteroids are currently indicated in moderate to severe COVID-19 patients.
Recovery trial has used dexamethasone. However, both IV dexamethasone or methyl
prednisolone may be used based on the availability.

6. What is the role of Tocilizumab?


Tocilizumab has been approved by DCGI on compassionate ground in view of
ongoing pandemic. However, it is an experimental therapy, has a limited role, and
should be used only in patients with cytokine syndrome after ruling out active
infections.
7. What is the role of Plasma therapy?
Convalescent plasma collected from ABO matched donors with high neutralizing
titers can be given to patients at risk of developing severe COVID in early stages of
All India Institute of Medical Sciences, New Delhi
National e-ICU on COVID-19 management
the disease. However, it should also be considered an experimental therapy and
should be used with caution.
8. Role of Favipiravir
Studies have used Favipiravir mainly in mild or asymptomatic COVID, claiming to
prevent progression, whereas majority of this cohort recover with just supportive
care and monitoring and usually require no specific therapy. Evidence is weak for
the use of Favipiravir and is currently not recommended in national guidelines.
9. Role of antifibrotic in prevention of lung fibrosis
There is no evidence to support the use of antifibrotic agents like pirfenidone in
preventing COVID related fibrosis and hence should not be used.
10. How to prevent depression in COVID 19 patients?
Depression is a common finding in patients with COVID which may be because of
number of reasons including staying in isolation, anxiety related to disease, social
stigma, among others. Such patients need empathy and psychological counselling
preferably by a trained HCW like a psychologist / psychiatrist.

11. Can we give Remdesivir/TCZ in a highly suspect 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 empirical therapy for
suspected cases. You should use these agents only in proven COVID patients, where
clinically indicated.
12. Can we try Methylene blue?

No, there is no role of methylene blue in the management of COVID.

13. How long can we give Remdesivir?

Remdesivir is currently recommended for 5 days in once daily dosing.

14. Can we use Remdesivir/TCZ prophylactically in asymptomatic patients with


comorbidities?
There is no evidence to support the use of Remdesivir/TCZ in asymptomatic patients
with comorbidities
15. Should relatives be allowed to visit COVID-19 patients admitted in the wards?

No, relatives are not allowed to visit COVID-19 patients as they have chances to get
infected and transfer it to the community.

16. Can parents be allowed to stay with COVID-19 positive children?

Parents can stay with the children after explaining the risk and taking consent for the
same.

17. Should we continue steroids on discharge?


All India Institute of Medical Sciences, New Delhi
National e-ICU on COVID-19 management
No, there is no role of steroids at the time of discharge unless indicated for any other
concomitant disease.

18. How do we maintain nutrition in a patient on ventilation?


Patients on ventilator may require TPN or Ryle’s tube feeding depending on their
underlying condition.

19. When should we shift from NIV to invasive ventilation?

If the patient is not able to maintain saturation, going into respiratory fatigue, or the
GCS is poor to tolerate NIV, they should be considered for invasive ventilation.

20. When should we consider a tracheostomy?

Patients in whom prolonged ventilation is anticipated should be considered for


tracheostomy.

Updated 01/09/2020

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