Recommendations on the In-Hospital Treatment of Patients with COVID-19.
| Title: | Recommendations on the In-Hospital Treatment of Patients with COVID-19. |
|---|---|
| Authors: | Kluge, Stefan, Malin, Jakob J., Fichtner, Falk, Müller, Oliver J., Skoetz, Nicole, Karagiannidis, Christian |
| Source: | Deutsches Ärzteblatt International; 12/17/2021, Vol. 118 Issue 50, p865-871, 8p |
| Abstract: | Background: The mortality of COVID-19 patients who are admitted to a hospital because of the disease remains high. The implementation of evidence-based treatments can improve the quality of care. Methods: The new clinical practice guideline is based on publications retrieved by a systematic search in the Medline databases via PubMed and in the Cochrane COVID-19 trial registry, followed by a structured consensus process leading to the adoption of graded recommendations. Results: Therapeutic anticoagulation can be considered in patients who do not require intensive care and have an elevated risk of thromboembolism (for example, those with D-dimer levels ≥ 2 mg/L). For patients in intensive care, therapeutic anticoagulation has no benefit. For patients with hypoxemic respiratory insufficiency, prone positioning and an early therapy attempt with CPAP/noninvasive ventilation (CPAP, continuous positive airway pressure) or high-flow oxygen therapy is recommended. Patients with IgG-seronegativity and, at most, low-flow oxygen should be treated with SARS-CoV-2-specific monoclonal antibodies (at present, casirivimab and imdevimab). Patients needing no more than low-flow oxygen should additionally be treated with janus kinase (JAK) inhibitors. All patients who need oxygen (low-flow, high-flow, noninvasive ventilation/CPAP, invasive ventilation) should be given systemic corticosteroids. Tocilizumab should be given to patients with a high oxygen requirement and progressively severe COVID-19 disease, but not in combination with JAK inhibitors. Conclusion: Noninvasive ventilation, high-flow oxygen therapy, prone positioning, and invasive ventilation are important elements of the treatment of hypoxemic patients with COVID-19. A reduction of mortality has been demonstrated for the administration of monoclonal antibodies, JAK inhibitors, corticosteroids, tocilizumab, and therapeutic anticoagulation to specific groups of patients. [ABSTRACT FROM AUTHOR] |
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| Database: | Complementary Index |
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| Items | – Name: Title Label: Title Group: Ti Data: Recommendations on the In-Hospital Treatment of Patients with COVID-19. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Kluge%2C+Stefan%22">Kluge, Stefan</searchLink><br /><searchLink fieldCode="AR" term="%22Malin%2C+Jakob+J%2E%22">Malin, Jakob J.</searchLink><br /><searchLink fieldCode="AR" term="%22Fichtner%2C+Falk%22">Fichtner, Falk</searchLink><br /><searchLink fieldCode="AR" term="%22Müller%2C+Oliver+J%2E%22">Müller, Oliver J.</searchLink><br /><searchLink fieldCode="AR" term="%22Skoetz%2C+Nicole%22">Skoetz, Nicole</searchLink><br /><searchLink fieldCode="AR" term="%22Karagiannidis%2C+Christian%22">Karagiannidis, Christian</searchLink> – Name: TitleSource Label: Source Group: Src Data: Deutsches Ärzteblatt International; 12/17/2021, Vol. 118 Issue 50, p865-871, 8p – Name: Abstract Label: Abstract Group: Ab Data: Background: The mortality of COVID-19 patients who are admitted to a hospital because of the disease remains high. The implementation of evidence-based treatments can improve the quality of care. Methods: The new clinical practice guideline is based on publications retrieved by a systematic search in the Medline databases via PubMed and in the Cochrane COVID-19 trial registry, followed by a structured consensus process leading to the adoption of graded recommendations. Results: Therapeutic anticoagulation can be considered in patients who do not require intensive care and have an elevated risk of thromboembolism (for example, those with D-dimer levels ≥ 2 mg/L). For patients in intensive care, therapeutic anticoagulation has no benefit. For patients with hypoxemic respiratory insufficiency, prone positioning and an early therapy attempt with CPAP/noninvasive ventilation (CPAP, continuous positive airway pressure) or high-flow oxygen therapy is recommended. Patients with IgG-seronegativity and, at most, low-flow oxygen should be treated with SARS-CoV-2-specific monoclonal antibodies (at present, casirivimab and imdevimab). Patients needing no more than low-flow oxygen should additionally be treated with janus kinase (JAK) inhibitors. All patients who need oxygen (low-flow, high-flow, noninvasive ventilation/CPAP, invasive ventilation) should be given systemic corticosteroids. Tocilizumab should be given to patients with a high oxygen requirement and progressively severe COVID-19 disease, but not in combination with JAK inhibitors. Conclusion: Noninvasive ventilation, high-flow oxygen therapy, prone positioning, and invasive ventilation are important elements of the treatment of hypoxemic patients with COVID-19. A reduction of mortality has been demonstrated for the administration of monoclonal antibodies, JAK inhibitors, corticosteroids, tocilizumab, and therapeutic anticoagulation to specific groups of patients. [ABSTRACT FROM AUTHOR] – Name: Abstract Label: Group: Ab Data: <i>Copyright of Deutsches Ärzteblatt International is the property of Deutscher Aerzte-Verlag GmbH and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.3238/arztebl.m2021.0374 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 8 StartPage: 865 Titles: – TitleFull: Recommendations on the In-Hospital Treatment of Patients with COVID-19. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Kluge, Stefan – PersonEntity: Name: NameFull: Malin, Jakob J. – PersonEntity: Name: NameFull: Fichtner, Falk – PersonEntity: Name: NameFull: Müller, Oliver J. – PersonEntity: Name: NameFull: Skoetz, Nicole – PersonEntity: Name: NameFull: Karagiannidis, Christian IsPartOfRelationships: – BibEntity: Dates: – D: 17 M: 12 Text: 12/17/2021 Type: published Y: 2021 Identifiers: – Type: issn-print Value: 18660452 Numbering: – Type: volume Value: 118 – Type: issue Value: 50 Titles: – TitleFull: Deutsches Ärzteblatt International Type: main |
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