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Table 4 Other therapies for patients with COVID-19 disease

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)

  1. Abbreviations: HFNC High-flow nasal cannula, CPAP Continuous positive airway pressure, NIV Non-invasive ventilation, BMI Body mass index