{"id":18867,"date":"2020-04-27T04:51:23","date_gmt":"2020-04-26T20:51:23","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=18867"},"modified":"2020-07-14T16:17:42","modified_gmt":"2020-07-14T08:17:42","slug":"nih%e6%96%b0%e5%86%a0%e7%97%85%e6%af%92%e6%84%9f%e6%9f%93%e6%b2%bb%e7%96%97%e6%8c%87%e5%8d%97","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=18867","title":{"rendered":"NIH\u65b0\u51a0\u75c5\u6bd2\u611f\u67d3\u6cbb\u7597\u6307\u5357"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">Persons at Risk for Infection with SARS-CoV-2<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Pre-Exposure Prophylaxis<\/h3>\n\n\n\n<p>The COVID-19 Treatment Guidelines Panel (the Panel)&nbsp;<strong>does not recommend<\/strong>&nbsp;the use of any agents for SARS-CoV-2 pre-exposure prophylaxis (PrEP) outside the setting of a clinical trial<strong>(AIII)<\/strong>.<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Post-Exposure Prophylaxis<\/h3>\n\n\n\n<p>The Panel\u00a0<strong>does not recommend<\/strong>\u00a0the use of any agents for SARS-CoV-2 post-exposure prophylaxis (PEP) outside the setting of a clinical trial\u00a0<strong>(AIII)<\/strong>.<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Management of Persons with COVID-19<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Asymptomatic or Presymptomatic Infection<\/h3>\n\n\n\n<p>The Panel recommends no additional laboratory testing and no specific treatment for persons with suspected or confirmed asymptomatic or presymptomatic SARS-CoV-2 infection (AIII).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Mild Illness<\/h3>\n\n\n\n<p>There are insufficient data to recommend either for or against any antiviral or immunomodulatory therapy in patients with COVID-19 with mild illness (AIII).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Moderate Illness<\/h3>\n\n\n\n<p>There are insufficient data for the Panel to recommend either for or against any antiviral or immunomodulatory therapy in patients with COVID-19 with moderate illness (AIII).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Severe Illness<\/h3>\n\n\n\n<p>There are insufficient data for the Panel to recommend either for or against any antiviral or immunomodulatory therapy in patients with COVID-19 with severe illness (AIII).<\/p>\n\n\n\n<h3 class=\"wp-block-heading\">Critical Illness<\/h3>\n\n\n\n<p>There are insufficient data for the Panel to recommend either for or against any antiviral or immunomodulatory therapy in critically ill patients with COVID-19 (AIII).<\/p>\n\n\n\n<h2 class=\"wp-block-heading\">Care of Critically Ill Patients with COVID-19<\/h2>\n\n\n\n<h2 class=\"wp-block-heading\">Infection Control:<\/h2>\n\n\n\n<ul><li>For health care workers who are performing aerosol-generating procedures on patients with COVID-19, the COVID-19 Treatment Guidelines Panel (the Panel) recommends using fit-tested respirators (N-95 respirators) or powered air-purifying respirators rather than surgical masks, in addition to other personal protective equipment (i.e., gloves, gown, and eye protection such as a face shield or safety goggles)&nbsp;<strong>(AIII)<\/strong>.<\/li><li>The Panel recommends that endotracheal intubation for patients with COVID-19 be done by health care providers with extensive airway management experience, if possible&nbsp;<strong>(AIII)<\/strong>.&nbsp;<\/li><li>The Panel recommends that intubation be achieved by video laryngoscopy, if possible<strong>(CIII)<\/strong>.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Hemodynamic Support:<\/h2>\n\n\n\n<ul><li>The Panel recommends norepinephrine as the first-choice vasopressor&nbsp;<strong>(AII)<\/strong>.<\/li><li>The Panel recommends using dobutamine in patients who show evidence of persistent hypoperfusion despite adequate fluid loading and the use of vasopressor agents&nbsp;<strong>(BII)<\/strong>.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Ventilatory Support:<\/h2>\n\n\n\n<ul><li>For adults with COVID-19 and acute hypoxemic respiratory failure despite conventional oxygen therapy, the Panel recommends high-flow nasal cannula (HFNC) oxygen over noninvasive positive pressure ventilation (NIPPV)&nbsp;<strong>(BI)<\/strong>.<\/li><li>In the absence of an indication for endotracheal intubation, the Panel recommends a closely monitored trial of NIPPV for adults with COVID-19 and acute hypoxemic respiratory failure for whom HFNC is not available&nbsp;<strong>(BIII)<\/strong>.<\/li><li>For adults with COVID-19 who are receiving supplemental oxygen, the Panel recommends close monitoring for worsening of respiratory status and recommends early intubation by an experienced practitioner in a controlled setting&nbsp;<strong>(AII)<\/strong>.<\/li><li>For mechanically ventilated adults with COVID-19 and acute respiratory distress syndrome (ARDS), the Panel recommends using low tidal volume (Vt) ventilation (Vt 4\u20138 mL\/kg of predicted body weight) over higher tidal volumes (Vt &gt;8 mL\/kg)&nbsp;<strong>(AI)<\/strong>.<\/li><li>For mechanically ventilated adults with COVID-19 and refractory hypoxemia despite optimized ventilation, the Panel recommends prone ventilation for 12 to 16 hours per day over no prone ventilation&nbsp;<strong>(BII)<\/strong>.<\/li><li>For mechanically ventilated adults with COVID-19, severe ARDS, and hypoxemia despite optimized ventilation and other rescue strategies, the Panel recommends a trial of inhaled pulmonary vasodilator as a rescue therapy; if no rapid improvement in oxygenation is observed, the patient should be tapered off treatment&nbsp;<strong>(CIII)<\/strong>.<\/li><li>There are insufficient data to recommend either for or against the routine use of extracorporeal membrane oxygenation for patients with COVID-19 and refractory hypoxemia<strong>&nbsp;(BIII)<\/strong>.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Drug Therapy:<\/h2>\n\n\n\n<ul><li>There are insufficient data for the Panel to recommend either for or against any antiviral or immunomodulatory therapy in patients with severe COVID-19 disease<strong>\u00a0(AIII)<\/strong>.<\/li><li>In patients with COVID-19 and severe or critical illness, there are insufficient data to recommend empiric broad-spectrum antimicrobial therapy in the absence of another indication\u00a0<strong>(BIII)<\/strong>.<\/li><li>The Panel\u00a0<strong>recommends against<\/strong>\u00a0the routine use of systemic corticosteroids for the treatment of mechanically ventilated patients with COVID-19 without ARDS\u00a0<strong>(BIII)<\/strong>.<\/li><li>In mechanically ventilated adults with COVID-19 and ARDS, there are insufficient data to recommend either for or against corticosteroid therapy in the absence of another indication\u00a0<strong>(CI)<\/strong>.<\/li><li>In COVID-19 patients with refractory shock, low-dose corticosteroid therapy is preferred over no corticosteroid therapy\u00a0<strong>(BII)<\/strong>.<\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Therapeutic Options for COVID-19 Currently Under Investigation<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Antivirals:<\/h3>\n\n\n\n<ul><li>There are insufficient clinical data to recommend either for or against using<strong>&nbsp;chloroquine<\/strong>or&nbsp;<strong>hydroxychloroquine<\/strong>&nbsp;for the treatment of COVID-19&nbsp;<strong>(AIII)<\/strong>.<ul><li>If chloroquine or hydroxychloroquine is used, clinicians should monitor the patient for adverse effects, especially prolonged QTc interval&nbsp;<strong>(AIII)<\/strong>.<\/li><\/ul><\/li><li>There are insufficient clinical data to recommend either for or against using the investigational antiviral drug&nbsp;<strong>remdesivir<\/strong>&nbsp;for the treatment of COVID-19<strong>&nbsp;(AIII)<\/strong>.<ul><li>Remdesivir as a treatment for COVID-19 is currently being investigated in clinical trials and is also available through expanded access and compassionate use mechanisms for certain patient populations.<\/li><\/ul><\/li><li>Except in the context of a clinical trial, the COVID-19 Treatment Guidelines Panel (the Panel)<strong>&nbsp;recommends against<\/strong>&nbsp;the use of the following drugs for the treatment of COVID-19:<ul><li>The combination of&nbsp;<strong>hydroxychloroquine plus azithromycin (AIII)<\/strong>&nbsp;because of the potential for toxicities.<\/li><li><strong>Lopinavir\/ritonavir (AI)<\/strong>&nbsp;or other<strong>&nbsp;HIV protease inhibitors (AIII)<\/strong>&nbsp;because of unfavorable pharmacodynamics and negative clinical trial data.<\/li><\/ul><\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Host Modifiers\/Immune-Based Therapy:<\/h3>\n\n\n\n<ul><li>There are insufficient clinical data to recommend either for or against the use of&nbsp;<strong>convalescent plasma<\/strong>&nbsp;or<strong>&nbsp;hyperimmune immunoglobulin<\/strong>&nbsp;for the treatment of COVID-19&nbsp;<strong>(AIII)<\/strong>.<\/li><li>There are insufficient clinical data to recommend either for or against the use of the following agents for the treatment of COVID-19&nbsp;<strong>(AIII)<\/strong>:<ul><li><strong>Interleukin-6 inhibitors<\/strong>&nbsp;(e.g., sarilumab, siltuximab, tocilizumab)<\/li><li><strong>Interleukin-1 inhibitors<\/strong>&nbsp;(e.g., anakinra)<\/li><\/ul><\/li><li>Except in the context of a clinical trial, the Panel<strong>&nbsp;recommends against<\/strong>&nbsp;the use of other immunomodulators, such as:<ul><li><strong>Interferons (AIII)<\/strong>, because of lack of efficacy in treatment of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) and toxicity.<\/li><li><strong>Janus kinase inhibitors<\/strong>&nbsp;(e.g., baricitinib)<strong>&nbsp;(AIII),<\/strong>&nbsp;because of their broad immunosuppressive effect.<\/li><\/ul><\/li><\/ul>\n\n\n\n<h2 class=\"wp-block-heading\">Considerations for Certain Concomitant Medications in Patients with COVID-19<\/h2>\n\n\n\n<h3 class=\"wp-block-heading\">Angiotensin-Converting Enzyme (ACE) Inhibitors and Angiotensin Receptor Blockers (ARBs):<\/h3>\n\n\n\n<ul><li>Persons with COVID-19 who are prescribed ACE inhibitors or ARBs for cardiovascular disease (or other indications) should continue these medications&nbsp;<strong>(AIII)<\/strong>.<\/li><li>The COVID-19 Treatment Guidelines Panel (the Panel)&nbsp;<strong>recommends against<\/strong>&nbsp;the use of ACE inhibitors or ARBs for the treatment of COVID-19 outside of the setting of a clinical trial&nbsp;<strong>(AIII)<\/strong>.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\"><strong>Corticosteroids<\/strong><\/h3>\n\n\n\n<p><em>For Critically Ill Patients with COVID-19:<\/em><\/p>\n\n\n\n<ul><li>The Panel&nbsp;<strong>recommends against<\/strong>&nbsp;the routine use of systemic corticosteroids for the treatment of mechanically ventilated patients with COVID-19 without acute respiratory distress syndrome (ARDS)<em>&nbsp;<\/em><strong>(AIII)<\/strong><em>.<\/em><\/li><li>For mechanically ventilated patients with ARDS, there is insufficient evidence to recommend for or against the use of systemic corticosteroids&nbsp;<strong>(CI)<\/strong>.<\/li><li>For adults with COVID-19 and refractory shock, the Panel recommends using low-dose corticosteroid therapy (i.e., shock reversal) over no corticosteroids&nbsp;<strong>(BII)<\/strong>.<\/li><\/ul>\n\n\n\n<p><em>For Hospitalized, Non-Critically Ill Patients with COVID-19:<\/em><\/p>\n\n\n\n<ul><li>The Panel&nbsp;<strong>recommends against<\/strong>&nbsp;the routine use of systemic corticosteroids for the treatment of COVID-19 in hospitalized patients, unless they are in the intensive care unit&nbsp;<strong>(AIII)<\/strong>.<\/li><\/ul>\n\n\n\n<p><em>For Patients on Chronic Corticosteroids:<\/em><\/p>\n\n\n\n<ul><li>Oral corticosteroid therapy used prior to COVID-19 diagnosis for another underlying condition (e.g., primary or secondary adrenal insufficiency, rheumatological diseases) should not be discontinued&nbsp;<strong>(AIII)<\/strong>. On a case-by-case basis, supplemental or stress-dose steroids may be indicated<strong>&nbsp;(AIII)<\/strong>.<\/li><li>Inhaled corticosteroids used daily for patients with asthma and chronic obstructive pulmonary disease for control of airway inflammation should not be discontinued in patients with COVID-19&nbsp;<strong>(AIII)<\/strong>.<\/li><\/ul>\n\n\n\n<p><em>Pregnancy Considerations:<\/em><\/p>\n\n\n\n<ul><li>The antenatal corticosteroids betamethasone and dexamethasone are known to cross the placenta and therefore are generally reserved for when administration is required for fetal benefit&nbsp;<strong>(BIII)<\/strong>. Other systemic corticosteroids do not cross the placenta, and pregnancy is not a reason to restrict their use if otherwise indicated&nbsp;<strong>(CIII)<\/strong>.<\/li><li>The American College of Obstetricians and Gynecologists&nbsp;<strong>recommends against<\/strong>&nbsp;offering antenatal corticosteroids for fetal benefit in the late preterm period (34 0\/7 weeks\u201336 6\/7 weeks) because the benefits of antenatal corticosteroids in the late preterm period are less well established<strong>&nbsp;(CIII)<\/strong>.<\/li><li>Modifications to care for these patients may be individualized, weighing the neonatal benefits of antenatal corticosteroid use with the risks of potential harm to the pregnant patient&nbsp;<strong>(CIII)<\/strong>.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">HMG-CoA Reductase Inhibitors (Statins):<\/h3>\n\n\n\n<ul><li>Persons with COVID-19 who are prescribed statin therapy for the treatment or prevention of cardiovascular disease should continue these medications&nbsp;<strong>(AIII)<\/strong>.<\/li><li>The Panel&nbsp;<strong>recommends against<\/strong>&nbsp;the use of statins for the treatment of COVID-19 outside of the setting of a clinical trial&nbsp;<strong>(AIII)<\/strong>.<\/li><\/ul>\n\n\n\n<h3 class=\"wp-block-heading\">Nonsteroidal Anti-Inflammatory Drugs (NSAIDs):<\/h3>\n\n\n\n<ul><li>Persons with COVID-19 who are taking NSAIDs for a co-morbid condition should continue therapy as previously directed by their physician&nbsp;<strong>(AIII)<\/strong>.<\/li><li>The Panel recommends that there be no difference in the use of antipyretic strategies (e.g., with acetaminophen or NSAIDs) between patients with or without COVID-19&nbsp;<strong>(AIII).<\/strong><\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Persons at Risk for Infection with SARS-CoV-2 Pre-Expos [&hellip;]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[25,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18867"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=18867"}],"version-history":[{"count":1,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18867\/revisions"}],"predecessor-version":[{"id":18868,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/18867\/revisions\/18868"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=18867"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=18867"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=18867"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}