AIIMS/ ICMR-COVID-19 National Task Force/

Joint Monitoring Group (Dte.GHS)

Ministry of Health & Family Welfare, Government of India
CLINICAL GUIDANCE FOR MANAGEMENT OF ADULT COVID-19 PATIENTS
23rd September 2021
COVID-19 patient

Mild disease Moderate disease Severe disease

Upper respiratory tract symptoms Any one of: Any one of:
(&/or fever) WITHOUT shortness 1. Respiratory rate > 24/min, breathlessness 1. Respiratory rate >30/min, breathlessness
of breath or hypoxia 2. SpO2: 90% to < 93% on room air 2. SpO2 < 90% on room air

Home Isolation & Care ADMIT IN WARD ADMIT IN ICU

Oxygen Support: Respiratory support
MUST DOs Ø Target SpO2: 92-96% (88-92% in patients with COPD). • Consider use of NIV (Helmet or face mask interface
ü Physical distancing, indoor mask depending on availability) in patients with increasing
use, strict hand hygiene. Ø Preferred devices for oxygenation: non-rebreathing face oxygen requirement, if work of breathing is LOW.
ü Symptomatic management mask. • Consider use of HFNC in patients with increasing oxygen
(hydration, anti-pyretics, anti- requirement.
tussive, multivitamins). Ø Awake proning encouraged in all patients requiring • Intubation should be prioritized in patients with high
supplemental oxygen therapy (sequential position work of breathing /if NIV is not tolerated.
ü Stay in contact with treating
changes every 2 hours). • Use conventional ARDSnet protocol for ventilatory
physician.
management.
ü Monitor temperature and oxygen
Anti-inflammatory or immunomodulatory therapy
saturation (by applying a SpO2 Ø Inj. Methylprednisolone 0.5 to 1 mg/kg in 2 divided Anti-inflammatory or immunomodulatory therapy
probe to fingers). doses (or an equivalent dose of dexamethasone) usually • Inj Methylprednisolone 1 to 2mg/kg IV in 2 divided
Seek immediate medical attention if: for a duration of 5 to 10 days. doses (or an equivalent dose of dexamethasone) usually
Ø Patients may be initiated or switched to oral route if for a duration 5 to 10 days.
o Difficulty in breathing
stable and/or improving.
o High grade fever/severe cough,
Anticoagulation
particularly if lasting for >5 days Anticoagulation • Weight based intermediate dose prophylactic
o A low threshold to be kept for Ø Conventional dose prophylactic unfractionated heparin unfractionated heparin or Low Molecular Weight
those with any of the high-risk or Low Molecular Weight Heparin (weight based e.g., Heparin (e.g., Enoxaparin 0.5mg/kg per dose SC BD).
features* enoxaparin 0.5mg/kg per day SC). There should be no There should be no contraindication or high risk of
contraindication or high risk of bleeding. bleeding.
MAY DOs Monitoring Supportive measures
Therapies based on low certainty of Ø Clinical Monitoring: Work of breathing, Hemodynamic • Maintain euvolemia (if available, use dynamic measures
evidence instability, Change in oxygen requirement. for assessing fluid responsiveness).
• If sepsis/septic shock: manage as per existing protocol
v Inhalational Budesonide (given Ø Serial CXR; HRCT chest to be done ONLY If there is and local antibiogram.
via Metered dose inhaler/ Dry worsening.
powder inhaler) at a dose of 800 •
Monitoring
mcg BD for 5 days) to be given if Ø Lab monitoring: CRP and D-dimer 48 to 72 hrly; CBC,
• Serial CXR; HRCT chest to be done ONLY if there is
symptoms (fever and/or cough) KFT, LFT 24 to 48 hrly; IL-6 levels to be done if
worsening.
are persistent beyond 5 days of deteriorating (subject to availability). • Lab monitoring: CRP and D-dimer 24-48 hourly; CBC,
disease onset. KFT, LFT daily; IL-6 to be done if deteriorating (subject to
availability).

After clinical improvement, discharge

as per revised discharge criteria.

EUA/Off label use (based on limited available evidence and only in specific circumstances):

Ø Remdesivir (EUA) may be considered ONLY in patients with

*High-risk for severe disease or mortality o Moderate to severe disease (requiring SUPPLEMENTAL OXYGEN), AND
ü Age > 60 years o No renal or hepatic dysfunction (eGFR <30 ml/min/m2; AST/ALT >5 times ULN (Not an
ü Cardiovascular disease, hypertension, and CAD absolute contradiction), AND
ü DM (Diabetes mellitus) and other immunocompromised
o Who are within 10 days of onset of symptom/s.
states
v Recommended dose: 200 mg IV on day 1 f/b 100 mg IV OD for next 4 days.
ü Chronic lung/kidney/liver disease
ü Cerebrovascular disease o Not to be used in patients who are NOT on oxygen support or in home settings
ü Obesity
Ø Tocilizumab (Off-label) may be considered when ALL OF THE BELOW CRITERIA ARE MET
o Presence of severe disease (preferably within 24 to 48 hours of onset of severe
disease/ICU admission).
o Significantly raised inflammatory markers (CRP &/or IL-6).
o Not improving despite use of steroids.
o No active bacterial/fungal/tubercular infection.
v Recommended single dose: 4 to 6 mg/kg (400 mg in 60kg adult) in 100 ml NS over 1
hour.