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Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19.
Nasa, Prashant; Chaudhry, Dhruva; Govil, Deepak; Daga, Mradul K; Jain, Ravi; Chhallani, Akshaykumar A; Krishna, Apoorv; Jagiasi, Bharat G; Juneja, Deven; Barthakur, Himadri S; Jha, Hrishikesh; Gurjar, Mohan; Rangappa, Pradeep; Aladakatti, Raghunath; Mishra, Rajesh C; Shetty, Rajesh M; Yadav, Rohit; Garg, Sandeep; Nandakumar, Sivakumar M; Samavedam, Srinivas; Ray, Sumit; Hadda, Vijay; Javeri, Yash; Munjal, Manish.
  • Nasa P; Department of Critical Care Medicine, NMC Specialty Hospital, Dubai, United Arab Emirates.
  • Chaudhry D; Professor and Head, Pulmonary and Critical Care Medicine, Post Graduate Institute of Medical Sciences (PGIMS), Rohtak, Haryana, India.
  • Govil D; Institute of Critical Care and Anesthesia, Medanta-The Medicity, Gurgaon, Haryana, India.
  • Daga MK; Department of Medicine, Maulana Azad Medical College, Delhi, India.
  • Jain R; Department of Critical Care Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India.
  • Chhallani AA; Akshjot Clinic, Mumbai, Maharashtra, India.
  • Krishna A; Department of Pulmonology and Critical Care, Hospital Regency Health, Kanpur, Uttar Pradesh, India.
  • Jagiasi BG; Department of Critical Care, Reliance Hospital, Navimumbai, Maharashtra, India.
  • Juneja D; Institute of Critical Care Medicine, Max Super Speciality Hospital, Delhi, India.
  • Barthakur HS; Department of Internal Medicine, Barthakur Clinic, Guwahati, Assam, India.
  • Jha H; Incharge, ICU, MRPSH, Near RIMS, Ranchi, Jharkhand, India.
  • Gurjar M; Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, Uttar Pradesh, India.
  • Rangappa P; Consultant Intensive Care Physician, Columbia Asia Referral Hospitals, Yeshwantpur, Bengaluru, Karnataka, India.
  • Aladakatti R; Department of Critical Care Medicine, Gopalagowda Shathaveri Memorial Hospital, Mysuru, Karnataka, India.
  • Mishra RC; Department of MICU, Shaibya Comprehensive Care Clinic, Ahmedabad, Gujarat, India.
  • Shetty RM; Department of Critical Care Medicine, Manipal Hospital Whitefield, Bengaluru, Karnataka, India.
  • Yadav R; Consultant Critical Care Medicine, Bansal Hospital, Bhopal, Madhya Pradesh, India.
  • Garg S; Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak Hospital, Delhi, India.
  • Nandakumar SM; Department of Critical Care, Royalcare Superspeciality Hospital, Coimbatore, Tamil Nadu, India.
  • Samavedam S; Department of Critical Care, Virinchi Hospital, Hyderabad, Telangana, India.
  • Ray S; Department of Critical Care Medicine, Holy Family Hospital, Delhi, India.
  • Hadda V; Department of Pulmonary, Critical Care and Sleep Medicine, AIIMS, Delhi, India.
  • Javeri Y; Department of Critical Care, Anesthesia and Emergency Medicine, Regency Health, Lucknow, Uttar Pradesh, India.
  • Munjal M; Medical Director, Mangalam Medicity Hospital, Jaipur, Chairman Jigyasa Foundation, Jaipur, Rajasthan, India.
Indian J Crit Care Med ; 25(11): 1280-1285, 2021 Nov.
Article in English | MEDLINE | ID: covidwho-1526937
ABSTRACT

INTRODUCTION:

There is strong evidence for the use of corticosteroid in the management of severe coronavirus disease-2019 (COVID-19). However, there is still uncertainty about the timing of corticosteroids. We undertook a modified Delphi study to develop expert consensus statements on the early identification of a subset of patients from non-severe COVID-19 who may benefit from using corticosteroids.

METHODS:

A modified Delphi was conducted with two anonymous surveys between April 30, 2021, and May 3, 2021. An expert panel of 35 experts was selected and invited to participate through e-mail. The consensus was defined as >70% votes in multiple-choice questions (MCQ) on Likert-scale type statements, while strong consensus as >90% votes in MCQ or >50% votes for "very important" on Likert-scale questions in the final round.

RESULTS:

Twenty experts completed two rounds of the survey. There was strong consensus for the increased work of breathing (95%), a positive six-minute walk test (90%), thorax computed tomography severity score of >14/25 (85%), new-onset organ dysfunction (using clinical or biochemical criteria) (80%), and C-reactive protein >5 times the upper limit of normal (70%) as the criteria for patients' selection. The experts recommended using oral or intravenous (IV) low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days and monitoring of oxygen saturation, body temperature, clinical scoring system, blood sugar, and inflammatory markers for any "red-flag" signs.

CONCLUSION:

The experts recommended against indiscriminate use of corticosteroids in mild to moderate COVID-19 without the signs of clinical worsening. Oral or IV low-dose corticosteroids (the equivalent of 6 mg/day dexamethasone) for 5-10 days are recommended for patients with features of disease progression based on clinical, biochemical, or radiological criteria after 5 days from symptom onset under close monitoring. HOW TO CITE THIS ARTICLE How to cite this article Nasa P, Chaudhry D, Govil D, Daga MK, Jain R, Chhallani AA, et al. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19. Indian J Crit Care Med 2021;25(11)1280-1285.
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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Journal: Indian J Crit Care Med Year: 2021 Document Type: Article Affiliation country: Jp-journals-10071-23923

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Prognostic study Language: English Journal: Indian J Crit Care Med Year: 2021 Document Type: Article Affiliation country: Jp-journals-10071-23923