From: COVID-19 multidisciplinary high dependency unit: the Milan model
Antipyretic | • Paracetamol 1 g intravenous/orally every 8 h (with the goal to keep fever under control in patients with respiratory insufficiency) for all patients with body temperature > 37 °C. • Alternative:  ○ Diclofenac 75 mg intravenous in 24 h.  ○ Metamizole 500 mg intravenous every 8 h. |
Systemic hypertension treatment | • Patients with systemic hypertension already on medication: antihypertensive therapy should be continued regardless of pharmacologic (ACE-inhibitor, sartan, beta-blocker) [73]. Diuretics should be discontinued to avoid hypovolemic status. • Patients that develop systemic hypertension during the hospitalization: treatment options include potassium-spring diuretics (spironolactone 50 mg × 2/die or potassium canreonate intravenous with a minimum dose of 100 mg × 2/die) associated with ACE-inhibitors or sartans. |
Hydration | • Hydration should be considered in all patients (especially patients with fever). • Before start of treatment with CPAP or NIV hydration should be provided in patients with signs of hypovolemia. |
Nutrition | • In patients that are able to eat in HFNC or nasal cannulas: self-sufficient oral feeding • CPAP or NIV-dependent: nasal feeding tube should be placed to provide enteral feeding (e.g.: isosource protein 25 Kcal/kg) • In selected cases parenteral feeding (after positioning of central arterial access):  ○ 1. BMI ≥ 20 provide at least 1080 kcal (speed:1,5 ml/kg/h)  ○ 2. BMI < 20 provide at least 1540 kcal (speed:1,5 ml/kg/h) |
Sedation | • Anxious state: Alprazolam (starting dose 0,25 mg × 2/die orally) • Psychomotor agitation, attempt to remove medical devices, tachypnoea: morphine bolus (2,5 mg i.v./s.c., max every 6 h) +/− Alprazolam (starting dose 0,25 mg × 2/die). At least 2 h between administration of alprazolam and morphine. |
End of life support | • Starting dose: syringe pump with morphine 10 mg + midazolam 5 mg + haloperidol 5 mg + metoclopramide 10 mg • Dose should be modified according to clinical condition of the patient |
Gastric protection | • Omeprazole 20 mg every 24 h orally/intravenous |
Home therapy that should not be discontinued during hospitalization | - Levothyroxine - Beta-blockers and others essential cardiological therapies - Insulin in diabetic patients (oral antihyperglycemic should be discontinued in case of P/F ratio < 300 or acute kidney injury) - Corticosteroid therapy (decalage should be encouraged based on clinical condition of underlying condition) |