Anti-shock and anti-hypoxemic treatment

[zakiyatasnim]

Antiviral therapy for timely elimination of pathogens

Early antiviral treatment may reduce the incidence of severe and critical forms of the disease. Despite the lack of clinical evidence for the efficacy of antiviral drugs, antiviral strategies based on the characteristics of SAR-CoV-2 are currently approved in accordance with the diagnostic and treatment protocols for COVID-19: prevention, control, diagnosis and treatment.

1 Antiviral treatment

At FAMZU, lopinavir/ritonavir (2 capsules, every 12 hours) in combination with arbidol (200 mg every 12 hours) was used as the main regimen. From the experience of treating 49 patients in our hospital, the average time to obtaining a negative viral nucleic acid test result for the first time was 12 days (95% CI: 8-15 days). The duration of a negative nucleic acid test result (negative more than 2 times in a row with intervals of ≥24 hours) was 13.5 days (95% CI: 9.5-17.5 days).

If the basic regimen is not effective, chloroquine phosphate can be used in adults aged 18 to 65 years (weight ≥50 kg: 500 mg bid; weight ≤50 kg: 500 mg bid for the first two days, 500 mg daily for the next five days).

Interferon inhalation is recommended in the diagnostic and treatment protocols for COVID-19. We recommend that it be performed in negative pressure rooms rather than general rooms due to the possibility of aerosol transmission.

Darunavir/cobicistat has some antiviral activity in an in vitro viral suppression assay based on experience in the treatment of AIDS patients, and side effects are relatively mild. For patients who are intolerant to lopinavir/ritonavir, darunavir/cobicistat (1 tablet daily) or favipiravir (initial dose of 1600 mg followed by 600 mg bid) is an alternative option after ethical review. Concomitant use of three or more antiviral agents is not recommended.

2 Course of treatment

The course of treatment with chloroquinophosphate should not exceed 7 days. The course of treatment with other regimens is not defined and is usually about 2 weeks. Antiviral drugs should be stopped if the results of nucleic acid testing from sputum samples remain negative more than 3 times.

During the progression from severe to critical stage of the disease, patients may develop severe hypoxemia, cytokine cascade and severe infections, which may develop into shock, tissue perfusion disorders israel number data and even multiple organ failure. Treatment is aimed at removing the stimuli and restoring fluid. Artificial liver support system (ALSS) and blood purification can effectively reduce inflammatory mediators and cytokine cascade and prevent the occurrence of shock, hypoxemia and respiratory distress syndrome.

1 Use of glucocorticoids when necessary

Appropriate and short-term use of corticosteroids to inhibit the cytokine cascade and prevent disease progression should be considered in patients with severe COVID-19 pneumonia as early as possible. However, high doses of glucocorticoids should be avoided due to adverse events and complications.

1.1 Indications for the use of corticosteroids

for those who are in a severe and critical stage of the disease;
for those who have persistent high fever (temperature above 39°C);
for those whose computed tomography (CT) scan showed patchy ground glass attenuation or more than 30% of the lungs were involved;
for those whose CT showed rapid progression (more than 50% of the area involved in the lung CT images within 48 hours);
for those whose IL-6 is higher than ≥ 5 ULN.
1.2 Use of corticosteroids