Abstract:Objective
Several therapies are being used or proposed for COVID-19, and many lack appropriate evaluations of their effectiveness and safety. The purpose of this document is to develop recommendations to support decisions regarding the pharmacological treatment of patients hospitalized with COVID-19 in Brazil.
Methods
A group of 27 experts, including representatives of the Ministry of Health and methodologists, created this guideline. The method used for the rapid devel… Show more
“…In newly emerging diseases, such as COVID-19, especially in a pandemic situation, interventions are mainly performed based on in vitro experiments, personal experiments, and small limited observational studies. The management of the disease depends largely on symptomatic and supportive treatments [14].…”
Section: Treatment Of Covid-19mentioning
confidence: 99%
“…Worldwide, several pharmacological interventions have been proposed for COVID-19, such as anticoagulants, antimicrobials, chloroquine, hydroxychloroquine, convalescent plasma, remdesivir, and tocilizumab [14]. For severely or critically ill patients with acute respiratory distress syndrome (ARDS) and sepsis, in addition to supplemental oxygen, mechanical ventilation and specific therapies for ARDS, antiviral and antibiotic treatments should also be considered [15,16].…”
Section: Treatment Of Covid-19mentioning
confidence: 99%
“…The potential benefit of its use would be in patients with moderate to severe ARDS, in selected cases and without suspicion of uncontrolled bacterial infection, 10-14 days after the onset of COVID-19 symptoms. The doses used in the studies ranged from 10 mg to 20 mg of dexamethasone and 40 mg to 120 mg of methylprednisolone per day for 5-10 days [14].…”
Section: Steroidsmentioning
confidence: 99%
“…For patients with signs of bacterial infection, with latent infections such as tuberculosis or parasitic, care should be given to the possibility of reactivation of these with the administration of tocilizumab. In immunosuppressed patients, its use should be with caution, and in neutropenic individuals (<500 cells/mm 3 ), thrombocytopenic (< 50,000 platelets/mm 3 ) or with transaminases at levels five times greater than physiological value, tocilizumab should not be used at all [14].…”
Section: Il-6 Antagonistsmentioning
confidence: 99%
“…But there is no recommendation for the use of intermediate doses in patients without signs of thromboembolism. Anticoagulants should be used, following a careful assessment of bleeding risk and presence of thrombocytopenias [14].…”
The new coronavirus first appeared in December 2019 in Wuhan, China, being officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV), as well as the name of the disease has been described as COVID-19 (coronavirus disease 2019). In March 2020, the disease was considered a global pandemic, with currently more than 514 million cases worldwide, with 6.4 million deaths. Severe cases of COVID-19 progress to acute respiratory distress syndrome (ARDS), on average about 8–9 days after the onset of symptoms. It is also worth mentioning that the severity of the disease in patients is not only due to the viral infection but also due to the host response. This phase, called a cytokine storm, reflects a state of systemic immune activation, with high levels of cytokines, such as IL-6, IL-1b, IL-2, IL-12, IL-18, TNF, and interferon gamma (IFN-γ). In this sense, the management of the disease largely depends on symptomatic and supportive treatments. For severely or critically ill patients with acute respiratory distress syndrome (ARDS) and sepsis, in addition to supplemental oxygen, mechanical ventilation, and ARDS-specific therapies, antiviral and antibiotic treatments should also be considered. Thus, the purpose of this chapter is to describe the pathophysiology and treatment of SARS-CoV-2 infection.
“…In newly emerging diseases, such as COVID-19, especially in a pandemic situation, interventions are mainly performed based on in vitro experiments, personal experiments, and small limited observational studies. The management of the disease depends largely on symptomatic and supportive treatments [14].…”
Section: Treatment Of Covid-19mentioning
confidence: 99%
“…Worldwide, several pharmacological interventions have been proposed for COVID-19, such as anticoagulants, antimicrobials, chloroquine, hydroxychloroquine, convalescent plasma, remdesivir, and tocilizumab [14]. For severely or critically ill patients with acute respiratory distress syndrome (ARDS) and sepsis, in addition to supplemental oxygen, mechanical ventilation and specific therapies for ARDS, antiviral and antibiotic treatments should also be considered [15,16].…”
Section: Treatment Of Covid-19mentioning
confidence: 99%
“…The potential benefit of its use would be in patients with moderate to severe ARDS, in selected cases and without suspicion of uncontrolled bacterial infection, 10-14 days after the onset of COVID-19 symptoms. The doses used in the studies ranged from 10 mg to 20 mg of dexamethasone and 40 mg to 120 mg of methylprednisolone per day for 5-10 days [14].…”
Section: Steroidsmentioning
confidence: 99%
“…For patients with signs of bacterial infection, with latent infections such as tuberculosis or parasitic, care should be given to the possibility of reactivation of these with the administration of tocilizumab. In immunosuppressed patients, its use should be with caution, and in neutropenic individuals (<500 cells/mm 3 ), thrombocytopenic (< 50,000 platelets/mm 3 ) or with transaminases at levels five times greater than physiological value, tocilizumab should not be used at all [14].…”
Section: Il-6 Antagonistsmentioning
confidence: 99%
“…But there is no recommendation for the use of intermediate doses in patients without signs of thromboembolism. Anticoagulants should be used, following a careful assessment of bleeding risk and presence of thrombocytopenias [14].…”
The new coronavirus first appeared in December 2019 in Wuhan, China, being officially named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by the International Committee on Taxonomy of Viruses (ICTV), as well as the name of the disease has been described as COVID-19 (coronavirus disease 2019). In March 2020, the disease was considered a global pandemic, with currently more than 514 million cases worldwide, with 6.4 million deaths. Severe cases of COVID-19 progress to acute respiratory distress syndrome (ARDS), on average about 8–9 days after the onset of symptoms. It is also worth mentioning that the severity of the disease in patients is not only due to the viral infection but also due to the host response. This phase, called a cytokine storm, reflects a state of systemic immune activation, with high levels of cytokines, such as IL-6, IL-1b, IL-2, IL-12, IL-18, TNF, and interferon gamma (IFN-γ). In this sense, the management of the disease largely depends on symptomatic and supportive treatments. For severely or critically ill patients with acute respiratory distress syndrome (ARDS) and sepsis, in addition to supplemental oxygen, mechanical ventilation, and ARDS-specific therapies, antiviral and antibiotic treatments should also be considered. Thus, the purpose of this chapter is to describe the pathophysiology and treatment of SARS-CoV-2 infection.
Objetivo: analisar os fatores relacionados ao desenvolvimento da Lesão Renal Aguda em pacientes com Covid-19 internados em uma Unidade de Terapia Intensiva. Método: estudo analítico, retrospectivo e transversal, realizado em Foz do Iguaçu, Brasil. Foram analisados os prontuários de 50 pacientes hospitalizados entre outubro/2020 a março/2021, por testes Qui-quadrado ou exato de Fischer atribuindo valor de p<0,05. Resultados: os fatores de risco identificados foram sexo masculino (52%), idade acima de 60 anos (62%), presença de comorbidades (94%), sobretudo a hipertensão arterial (68%), uso de ventilação mecânica por tempo maior que sete dias (60%), internação hospitalar acima de sete dias (82%) e uso de antibióticos (94%) e corticosteroides (96%). A maioria dos pacientes que necessitaram de hemodiálise (32%), ventilação mecânica (78%) e com hipertensão arterial (56%) evoluiu ao óbito (78%), com evidência estatística (p<0,0009). Conclusões: os fatores de risco podem ter contribuído para a progressão da doença e para a mortalidade.
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