Θεραπευτικός αλγόριθμος αντιμετώπισης νοσηλευόμενων ασθενών με COVID-19

Πανεπιστημιακό Γενικό Νοσοκομείο Πατρών, Πνευμονολογικό Τμήμα

Χαρακτηριστικά νόσου Θεραπευτική παρέμβαση

remdesivir (5 , 200 mg x1 1
έ , 100mg x1 έ ),
δ ζ 6mg x1,
φ δ
1-4

ύ ύ δ ζ 8mg x1,
PaO2/FiO2<200 tocilizumab 8 mg/kg baricitinib 4 mg ( 2mg
GFR=30-60 mL/min/1·73 m2)2,5,6

Α SaO2 93-96% Δ ζ
.Η έ
.7,8

Θ δ-δ έ CTPA
φ .
Δ
.4

Π .
Α ζ Δ
ύ φ (>11.000 COVID-19.9
Κ/ L), ύ δ ζ ,
έ δ ύ

ύ Εφ Helmet-CPAP, PEEP 10 cm H2Ο

PaO2/FiO2<100
Α ύ ,( ,
ύ )
PaO2/FiO2<80 δ

έ remdesivir,
ύ
δ

Tociluzumab Αναστολεας IL6

Baricitinib Αναστολέας Jak1 & 2 (Olumiant)
Veclury (Remdesivir)
Αντιπηκτικα : Arixtra (fondaparinux) Αναστολέας παράγοντα Xa
Clexane (ενοξαπαρίνη) ηπαρίνη ΧΜΒ

Βιβλιογραφία
1. Gottlieb RL, Vaca CE, Paredes R, et al. Early Remdesivir to Prevent
Progression to Severe Covid-19 in Outpatients. New England Journal of
Medicine. 2021.
2. RECOVERY Collaborative Group; P. Horby WSL, J.R. Emberson , M.
Mafham , J.L. Bell, L. Linsell, N. Staplin , C. Brightling , A. Ustianowski, E.
Elmahi, B. Prudon, C. Green , T. Felton , D. Chadwick , K. Rege, C. Fegan ,
L.C. Chappell , S.N. Faust , T. Jaki , K. Jeffery , A. Montgomery , K. Rowan ,
E. Juszczak , J.K. Baillie , R. Haynes , M.J. Landray. Dexamethasone in
Hospitalized Patients with Covid-19. New England Journal of Medicine.
2020;384(8):693-704.
3. Maskin LP, Bonelli I, Olarte GL, et al. High- Versus Low-Dose
Dexamethasone for the Treatment of COVID-19-Related Acute Respiratory
Distress Syndrome: A Multicenter, Randomized Open-Label Clinical Trial.
Dec 13 2021:8850666211066799.
4. Lopes RD, de Barros ESPGM, Furtado RHM, et al. Therapeutic versus
prophylactic anticoagulation for patients admitted to hospital with COVID-19
and elevated D-dimer concentration (ACTION): an open-label, multicentre,
randomised, controlled trial. Lancet (London, England). Jun 12
2021;397(10291):2253-2263.
5. Karampitsakos T, Malakounidou E, Papaioannou O, et al. Tocilizumab
improves 28-day survival in hospitalized patients with severe COVID-19: an
open label, prospective study. Respiratory research. Dec 22 2021;22(1):317.
6. Marconi VC, Ramanan AV, de Bono S, et al. Efficacy and safety of baricitinib
for the treatment of hospitalised adults with COVID-19 (COV-BARRIER): a
randomised, double-blind, parallel-group, placebo-controlled phase 3 trial. The
Lancet. Respiratory medicine. Dec 2021;9(12):1407-1418.
7. Ni YN, Wang YM, Liang BM, Liang ZA. The effect of hyperoxia on mortality
in critically ill patients: a systematic review and meta analysis. BMC
pulmonary medicine. Feb 26 2019;19(1):53.
8. Gelissen H, de Grooth HJ, Smulders Y, et al. Effect of Low-Normal vs High-
Normal Oxygenation Targets on Organ Dysfunction in Critically Ill Patients:
A Randomized Clinical Trial. Jama. Sep 14 2021;326(10):940-948.
9. Azithromycin for community treatment of suspected COVID-19 in people at
increased risk of an adverse clinical course in the UK (PRINCIPLE): a
randomised, controlled, open-label, adaptive platform trial. Lancet (London,
England). Mar 20 2021;397(10279):1063-1074.