Infectious Diseases I

ii.

Fluid resuscitation: Conservative management strategy using balanced crystalloid solutions

iii.

Vasopressors: Norepinephrine as first line; vasopressin or epinephrine as second line

iv.

Inotropes: Dobutamine if cardiac dysfunction or persistent hypoperfusion despite fluid resusci-

tation and norepinephrine

Corticosteroids: See Immunomodulation section in the text that follows.

vi.

Empiric antibiotic therapy should be reserved for patients with confirmed of high suspicion of

concomitant bacterial infection.

Anticoagulation without contraindication or other compelling indication for therapeutic

anticoagulation

Hospitalized patients not requiring oxygen should receive prophylactic heparin

ii.

In non-ICU and non-pregnant hospitalized patients requiring conventional oxygen therapy

AND with a d-Dimer above the upper limit of normal should receive therapeutic heparin for 14

days or until they are transferred to the ICU or discharged from the hospital, whichever comes

first. Pregnant patients should receive prophylactic heparin as appropriate.

iii.

Hospitalized patients requiring high-flow oxygen, noninvasive or invasive mechanical ventila-

tion, or ECMO should receive prophylactic heparin.

Corticosteroids

6 mg per day orally or intravenously for up to 10 days or until hospital discharge is

recommended for COVID-19 treatment in hospitalized patients requiring increased

amounts of supplemental oxygen or MV or ECMO.

label trial comparing dexamethasone 6 mg orally or intravenously once daily for up

to 10 days with usual care alone in 6425 patients (dexamethasone 2104; usual care

4321) hospitalized with COVID-19. At baseline, 3883 patients required supplemental

oxygen, and 1007 required MV.

22.9% vs. usual care 25.7%; age-adjusted rate ratio 0.83; 95% CI, 0.75–0.93;

p<0.001).

ratio 0.64; 95% CI, 0.51–0.81) and those receiving supplemental oxygen (23.3%

vs. 26.2%; rate ratio 0.82; 95% CI, 0.72–0.94). There was no difference among

patients not requiring respiratory support.

conducted a meta-analysis of seven controlled trials encompassing 1703 critically ill

patients (requiring supplemental oxygen or MV) with COVID-19, including 1007 patients

(15.7% of end enrollment) enrolled early in RECOVERY, showed that corticosteroids were

associated with lower 28-day all-cause mortality compared with placebo or usual care (OR

0.66 [95% CI, 0.53–0.82]; p<0.001).

6 mg or 12 mg daily for up to 10 days in 982 hospitalized patients.

range [IQR] 4.0–28.0) vs. 22.0 days (IQR 6.0–28.0) (adjusted mean difference 1.3 days

(95% CI, 0–2.6; p=0.07).

ii.

Other immunomodulators