Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19

Falavigna, Maicon; Stein, Cinara; Amaral, José Luiz Gomes do; Azevedo, Luciano César Pontes; Belli, Karlyse Claudino; Colpani, Verônica; Cunha, Clóvis Arns da; Dal‐Pizzol, Felipe; Dias, Maria Beatriz Souza; Ferreira, Juliana Carvalho; Freitas, Ana Paula; Gräf, Débora Dalmas; Guimarães, Hélio Penna; Lobo, Suzana Margareth; Monteiro, José Tadeu Colares; Nunes, Michelle Silva; Oliveira, Maura Salaroli de; Prado, Clementina Corah Lucas; Santos, Vania Cristina Canuto; Silva, Rosemeri Maurici da; Sobreira, Marcone Lima; Veiga, Viviane Cordeiro; Vidal, Ávila Teixeira; Xavier, Ricardo Machado; Zavascki, Alexandre Prehn; Machado, Flávia Ribeiro; Carvalho, Carlos Roberto Ribeiro

doi:10.5935/0103-507x.20220001-pt

Cited by 4 publications

(3 citation statements)

References 45 publications

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“…The Brazilian guidelines for the pharmacological treatment of hospitalised patients with COVID-19 provide 16 recommendations that include treatment with corticosteroids in patients receiving supplemental oxygen and the use of prophylactic doses of anticoagulants for venous thromboembolism. In contrast, several medications were not recommended for this population, and even some studies on them, have been retracted [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Barbosa,

Chebabo,

Starling

et al. 2023

Ann Clin Microbiol Antimicrob

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Background Since the beginning of the COVID-19 pandemic, therapeutic options for treating COVID-19 have been investigated at different stages of clinical manifestations. Considering the particular impact of COVID-19 in the Americas, this document aims to present recommendations for the pharmacological treatment of COVID-19 specific to this population. Methods Fifteen experts, members of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API) make up the panel responsible for developing this guideline. Questions were formulated regarding prophylaxis and treatment of COVID-19 in outpatient and inpatient settings. The outcomes considered in decision-making were mortality, hospitalisation, need for mechanical ventilation, symptomatic COVID-19 episodes, and adverse events. In addition, a systematic review of randomised controlled trials was conducted. The quality of evidence assessment and guideline development process followed the GRADE system. Results Nine technologies were evaluated, and ten recommendations were made, including the use of tixagevimab + cilgavimab in the prophylaxis of COVID-19, tixagevimab + cilgavimab, molnupiravir, nirmatrelvir + ritonavir, and remdesivir in the treatment of outpatients, and remdesivir, baricitinib, and tocilizumab in the treatment of hospitalised patients with severe COVID-19. The use of hydroxychloroquine or chloroquine and ivermectin was discouraged. Conclusion This guideline provides recommendations for treating patients in the Americas following the principles of evidence-based medicine. The recommendations present a set of drugs that have proven effective in the prophylaxis and treatment of COVID-19, emphasising the strong recommendation for the use of nirmatrelvir/ritonavir in outpatients as the lack of benefit from the use of hydroxychloroquine and ivermectin.

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Section: Discussionmentioning

confidence: 99%

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Barbosa,

Chebabo,

Starling

et al. 2023

Ann Clin Microbiol Antimicrob

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“…The hospital developed institutional protocols specifically for COVID-19 patients, since the beginning of the pandemic, including the best evidence that emerged related to the care of critically ill patients with COVID-19. The main treatment protocol changes between 2020 and 2021 were use of corticosteroid in hypoxemic patients, use of prophylactic doses of anticoagulants to patients without evidence of thromboembolism, use of antibiotics restricted to patients with suspected secondary bacterial infection [ 29 ] and reduced restrictions for the use of noninvasive ventilation (NIV) and high-flow nasal cannula (HFNC).…”

Section: Methodsmentioning

confidence: 99%

“…The median ICU stay was 11 [6][7][8][9][10][11][12][13][14][15][16][17][18][19] days in the first wave and 10 (7-19) in the second wave(p = 0.445). Hospital stay was longer, 21 days [14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32], on the second wave compared to the first wave, 17 days [11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27], p<0.001. More patients in first wave required mechanical ventilation (80% vs 70%, p<0.001), while the...…”

Section: Icu and Hospital Outcomesmentioning

confidence: 99%

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Freitas,

Costa,

Zimmermann

et al. 2024

PLoS ONE

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Background The emergence of SARS-CoV-2 variants led to subsequent waves of COVID-19 worldwide. In many countries, the second wave of COVID-19 was marked by record deaths, raising the concern that variants associated with that wave might be more deadly. Our aim was to compare outcomes of critically-ill patients of the first two waves of COVID-19. Methods This retrospective cohort included critically-ill patients admitted between March-June 2020 and April-July 2021 in the largest academic hospital in Brazil, which has free-access universal health care system. We compared admission characteristics and hospital outcomes. The main outcome was 60‐day survival and we built multivariable Cox model based on a conceptual causal diagram in the format of directed acyclic graph (DAG). Results We included 1583 patients (1315 in the first and 268 in the second wave). Patients in the second wave were younger, had lower severity scores, used prone and non-invasive ventilatory support more often, and fewer patients required mechanical ventilation (70% vs 80%, p<0.001), vasopressors (60 vs 74%, p<0.001), and dialysis (22% vs 37%, p<0.001). Survival was higher in the second wave (HR 0.61, 95%CI 0.50–0.76). In the multivariable model, admission during the second wave, adjusted for age, SAPS3 and vaccination, was not associated with survival (aHR 0.85, 95%CI 0.65–1.12). Conclusions In this cohort study, patients with COVID-19 admitted to the ICU in the second wave were younger and had better prognostic scores. Adjusted survival was similar in the two waves, contrasting with record number of hospitalizations, daily deaths and health system collapse seen across the country in the second wave. Our findings suggest that the combination of the burden of severe cases and factors such as resource allocation and health disparities may have had an impact in the excess mortality found in many countries in the second wave.

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Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study

Nienkotter,

Gambetta,

Rocha

et al. 2023

Rev. Assoc. Med. Bras.

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SUMMARY OBJECTIVE: This study aimed to analyze the clinical-epidemiological profile, possible risk predictors, and outcomes of patients with coronavirus disease 2019 admitted to the ward of a tertiary care hospital in southern Brazil. Specifically, we describe the demographic characteristics, comorbidities, baseline laboratory findings, clinical course, and survival of these patients. METHODS: This is an observational, retrospective cohort study, performed from January to March 2022, on medical records of patients hospitalized between April 2020 and December 2021 in the coronavirus disease 2019 ward of a tertiary hospital in southern Brazil. RESULTS: Data from 502 hospitalized patients were analyzed, of which 60.2% were male, with a median age of 56 years and 31.7% were over 65 years old. The main symptoms presented were dyspnea/respiratory discomfort (69.9%) and cough (63.1%). The most common comorbidities were obesity, systemic arterial hypertension, and diabetes mellitus. A proportion of 55.8% of 493 patients had PaO 2 /FiO 2 <300 mmHg in the first examination performed after admission and 46.0% had a neutrophil/lymphocyte ratio>6.8. Oxygen therapy by Venturi mask or mask with reservoir was used in 34.7% of the patients, and non-invasive ventilation was used in 10.0% of the patients. The majority of the patients (98.4%) used corticosteroids, and the outcome of 82.5% of the hospitalized patients was home discharge. CONCLUSION: After analyzing the clinical and epidemiological profile, it can be concluded that age greater than 65 years and pulmonary involvement >50% are predictors of a worse prognosis for coronavirus disease 2019, as is the need for high-flow oxygen therapy. Corticotherapy, however, proved to be beneficial in the treatment of the disease.

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Diretrizes Brasileiras para o tratamento farmacológico de pacientes hospitalizados com COVID-19

Cited by 4 publications

References 45 publications

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Pan-American Guidelines for the treatment of SARS-CoV-2/COVID-19: a joint evidence-based guideline of the Brazilian Society of Infectious Diseases (SBI) and the Pan-American Association of Infectious Diseases (API)

Temporal trends of severity and outcomes of critically ill patients with COVID-19 after the emergence of variants of concern: A comparison of two waves

Analysis of possible risk predictors in patients with coronavirus disease 2019: a retrospective cohort study

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