Temporary guidelines

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

PREVENTION, DIAGNOSIS AND TREATMENT OF NEW CORONAVIRUS INFECTION (2019-nCoV)

Version 2 (February 2, 2020)

WHOLE DOCUMENT DOWNLOAD https://medsilica.com/download/prevention-diagnosis-and-treatment-of-new-coronavirus-infection-2019-ncov/

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4.2 Pathogenetic (symptomatic) treatment

A sufficient amount of fluid (2.5-3.5 liters per day or more, if there are no contraindications for somatic pathology). In cases of severe intoxication, abdominal pain, nausea and/or vomiting, edematous syndrome, which impedes fluid intake, oral intestinal adsorbents (enterosorbents) are recommended (colloidal silicon dioxide, polymethylsiloxane polyhydrate, etc.).

On indication, patients in serious condition (resuscitation and intensive care unit), undergo infusion therapy under mandatory monitoring of their condition, including blood pressure, lung auscultation images, hematocrit (not lower than 0.35 l/l) and diuresis. Infusion therapy should be performed with care, as excessive fluid transfusions can impair blood oxygen saturation, especially in conditions of limited mechanical ventilation. In order to prevent cerebral edema and pulmonary edema, it is advisable to carry out infusion therapy against the background of forced diuresis (lasix/furosemide 1% 2-4 ml IM or IV bolus). In order to improve sputum discharge during productive cough, mucoactive drugs are prescribed (acetylcysteine, ambroxol, carbocysteine, combined preparations, including herbal remedies based on ivy, thyme, primrose extract).

Bronchodilator inhalation (using a nebulizer) therapy using salbutamol, fenoterol, combined drugs (ipratropium bromide + fenoterol) is advisable in the presence of bronchial obstructive syndrome.

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4.5 The basic principles of treatment of emergency conditions in coronavirus infection

4.5.1 Intensive care for acute respiratory failure

Indications for ICU (one of the criteria is sufficient)

• initial manifestations and clinical picture of rapidly progressive acute respiratory failure:
• increasing and severe shortness of breath;
• cyanosis;
• RR > 30 per minute;
• SpO2 < 90%;
• blood pressure BPsyst <90 mm Hg;
• shock (marbling of limbs, acrocyanosis, cold limbs, symptom of a port-wine stain (> 3 sec), lactate more than 3 mmol/l);
• dysfunction of the central nervous system (Glasgow Coma Scale less than 15 scores);
• acute renal failure (urination <0.5 ml/kg/ h for 1 hour or a double increase in creatinine level from the normal value);
• hepatic dysfunction (an increase in bilirubin content above 20 μmol/l for 2 days or at least a twofold increase in transaminases than normal);
• coagulopathy (platelet count <100 thousand/μl or their decrease by 50% of the highest value within 3 days).

It is necessary to ensure a sufficient amount of fluid in the absence of contraindications and a decrease in diuresis (5-6 ml/kg/h), the total amount of which can rise with increased losses from the GIT (vomiting, loose stools). Use oral intestinal adsorbents (enterosorbents) (colloidal silicon dioxide, polymethylsiloxane polyhydrate, etc.).

On indication, patients in serious condition undergo infusion therapy on the basis of calculations of 5-6-8 ml/kg/h with mandatory monitoring of urine output and assessment of fluid distribution.

 

 

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