COVID-19 TREATMENT GUIDELINEIN TANZANIA, MARCH 2021
Posted by ULY CLINIC
24 Machi 2021 15:12:58
The guidance is based on proper case management aspects intended for clinicians involved in the care of patients with suspected or confirmed COVID-19. It is not meant to replace clinical judgment or specialist consultation but rather to strengthen frontline clinical management and the public health response.
NOTE. THIS GUIDELINE IS THE POPERTY OF MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDREN
6. MECHANICAL VENTILATION
Patients with hypoxemic respiratory failure may require intubation and mechanical ventilator support. Detailed recommendations on ventilation strategies are beyond the scope of this guideline. Always consult an intensivist if possible, or alternatively a practitioner experienced with mechanical ventilation.
Nonetheless, the general principles to consider include:
• Individualize ventilator strategies based on respiratory mechanics and disease progression.
• Use lung-protective ventilation strategies for patients with established ARDS who have low lung compliance.
• Aim for an initial tidal volume of 4-6ml/kg, higher tidal volume up to 8 ml/kg predicted body weight might be needed if minute ventilation requirements are not met in a patient with good lung compliance.
• Strive to achieve the lowest plateau pressure possible. Plateau pressures above 30 cmH20 are associated with an increased risk of pulmonary injury.
• Hypercapnia is permitted if meeting the pH goal of >7.15-7.20.
• Application of prone ventilation 12-16 hours a day is strongly recommended for patients with severe ARDS.
• In patients with moderate or severe ARDS, identifying optimal PEEP levels will require titration of
• The use of deep sedation may be required to control respiratory drive, achieve tidal volume targets, and assist with patient-ventilator dyssynchrony.
• In patients with moderate-severe ARDS (SPO2<80%), neuromuscular blockade by continuous infusion should not be routinely used. Continuous neuromuscular blockade may still be considered in patients with ARDS in certain situations: ventilator dyssynchrony despite
• Sedation, such that tidal volume limitation cannot be reliably achieved; or refractory hypoxemia.
• Avoid disconnecting the patient from the ventilator, which results in loss of PEEP and atelectasis.
Use closed system catheters for airway suctioning and clamp endotracheal tube when disconnection is required (for example, transfer to a transport ventilator). A high efficiency particulate filter on the expiratory limb of the ventilator circuit should be used.
Routine Care –for intubated patients
Use principle FAST HUGS BIB
• F Feeding
• A Analgesia
• S Sedation
• T Thromboembolic prophylaxis
• H Head of Bed Elevated
• U Ulcer prophylaxis
• G Glycaemic control
• S Spontaneous breathing trial
• B Bowel regimen
• I Indwelling catheters and lines
• D Deescalate ,Antibiotics
• Assure the type of diet the patient is receiving.
• Ensure optimal diet is provided
• If NPO, perform regular assessments if oral feeding is indicated
• If projected to be NPO for a long time, ensure consultation is made for TPN be considered.
• Ensure adequate pain control
• Assess regularly on the need for non-opioid adjuncts
• Consider adding oral analgesics instead of IV infusions
• Ensure sedation is minimized as much as possible
• Assess for non-benzodiazepine strategy use.
T Thromboembolic prophylaxis
• Ensure the patient is receiving VTE prophylaxis
• Assess for possible VTE adjustment for renal function.
H Head of Bed Elevated
• Head elevation to at least 30 degrees.
U Ulcer prophylaxis
• Assess for and provide stress ulcer prophylaxis
• Discontinued stress ulcer prophylaxis when indicated
G Glycaemic control
• Ensure adequate glycemic control (blood glucose target generally 6-10mmol/L).
S Spontaneous breathing trial
• Perform weaning protocol to assess if the patient qualifies for a spontaneous breathing
B Bowel regimen
I Indwelling catheters and lines
D Deescalate ,Antibiotics
B Bowel regimen
• Assess for bowel routines
I Indwelling catheters and lines
• Assess if the central line or arterial line can be removed.
• Regularly assess for the indication of a Foley catheter.
D Deescalate ,Antibiotics
• Assess and judge for patient’s antibiotics use, be narrowed or discontinued
25 Machi 2021 07:26:22
1. THE UNITED REPUBLIC OF TANZANIA. MINISTRY OF HEALTH, COMMUNITY DEVELOPMENT, GENDER, ELDERLY AND CHILDRENCORONAVIRUS DISEASE 2019 (COVID-19) TREATMENT GUIDELINES. MARCH 2021
2. Del Rio, C. and P.N. Malani, (2020). 2019 Novel Coronavirus—Important Information for Clinicians. JAMA, 2020. 323(11): p. 1039-1040.
3. World Health Organization, (2020). Coronavirus disease 2019 (COVID-19) Situation Report 46, 2020.
4. World Confederation of Physical Therapists (WCPT) (2020). Physiotherapy management for COVID 19 version 1.0 23 March 2020
5. Sohrabi, C., Z. Alsafi, N. O'Neill, M. Khan, A. Kerwan, A. Al-Jabir, C. Iosifidis, and R. Agha, (2020). World Health Organization declares global emergency: A review of the 2019 novel coronavirus (COVID-19). Int J Surg, 2020. 76: p. 71-76.
6. Guan, W.-j., … Ye, C.-j. Zhu, S.-y. and Zhong N.-s., (2020). Clinical Characteristics of Coronavirus Disease 2019 in China. NewEngland Journal of Medicine, 2020.
7. van Doremalen, N., … Lloyd-Smith, J.O., de Wit, E., and Munster, V.J., (2020). Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. New England Journal of Medicine, 2020.
8. Yoon, S.H., K.H. Lee, J.Y. Kim, Y.K. Lee, H. Ko, K.H. Kim, C.M. Park, and Y.H. Kim, Chest Radiographic and CT Findings of the 2019 Novel Coronavirus Disease (COVID-19): Analysis of Nine Patients Treated in Korea. Korean J Radiol, 2020. 21(4): p. 494-500.
9. Zhao, D., F. Yao, L. Wang, L. Zheng, Y. Gao, J. Ye, F. Guo, H. Zhao, and R. Gao, A comparative study on the clinical features of COVID-19 pneumonia to other pneumonias. Clin Infect Dis, 2020.
10. Peng, Q.Y., X.T. Wang, L.N. Zhang, and G. Chinese Critical Care Ultrasound Study, Findings of lung ultrasonography of novel corona virus pneumonia during the 2019-2020 epidemic. Intensive Care Med, 2020.
11. Chen, N., M. Zhou, X. Dong, J. Qu, F. Gong, Y. Han, Y. Qiu, J. Wang, Y. Liu, Y. Wei, J. Xia,
T. Yu, X. Zhang, and L. Zhang, Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet, 2020. 395(10223): p. 507-51s3.
12. Zhou, F., T. Yu, R. Du, G. Fan, Y. Liu, Z. Liu, J. Xiang, Y. Wang, B. Song, X. Gu, L. Guan, Y. Wei, H. Li, X. Wu, J. Xu, S. Tu, Y. Zhang, H. Chen, and B. Cao, Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet, 2020.
13. Xie, J., Z. Tong, X. Guan, B. Du, H. Qiu, and A.S. Slutsky, Critical care crisis and some recommendations during the COVID-19 epidemic in China. Intensive Care Medicine, 2020.
14. Australian and New Zealand Intensive Care Society, ANZICS COVID-19 Guidelines, 202, ANZICS: Melbourne.
15. Kress, J.P. and J.B. Hall, (2014). ICU-acquired weakness and recovery from critical illness.
N Engl J Med, 2014. 370(17): p. 1626-35.
16. Herridge, M.S., C.M. Tansey, A. Matte, G. Tomlinson, N. Diaz-Granados, A. Cooper, C.B. Guest, C.D. Mazer, S. Mehta, T.E. Stewart, P. Kudlow, D. Cook, A.S. Slutsky, and A.M. Cheung, (2011). Functional disability 5 years after acute respiratory distress syndrome. N Engl JMed, 2011. 364(14): p. 1293-304.
17. Brouwers, M.C., M.E. Kho, G.P. Browman, J.S. Burgers, F. Cluzeau, G. Feder, B. Fervers,
I.D. Graham, S.E. Hanna, and J. Makarski, (2010). Development of the AGREE II, part 1: performance, usefulness and areas for improvement. Cmaj, 2010. 182(10): p. 1045-52.
18. Schunemann, H.J., …Cuello, R. Waziry,and Akl, E.A., (2017). GRADE Evidence to Decision (EtD) frameworks for adoption, adaptation, and de novo development of trustworthy recommendations: GRADE-ADOLOPMENT. J Clin Epidemiol, 81: p. 101-110.
19. Moberg, J., A.D., …Morelli, G. Rada, and P. Alonso-Coello, (2018). The GRADE Evidence to Decision (EtD) framework for health system and public health decisions. Health Res Policy Syst, 16(1): p. 45.
20. Clinical Skills Development Service, Q.H. Physiotherapy and Critical Care Management eLearning Course. Accessed 21/3/20]; Available at https://central.csds.qld.edu.au/central/courses/108].
21. World Health Organisation, (2020). Infection prevention and control during health care when COVID-19 is suspected: Interim Guidance, M. 2020, Editor 2020.
22. Queensland Health,(2020). Clinical Excellence Division COVID-19 Action Plan: Statewide General Medicine Clinical Network,
23. The Faculty of Intensive Care Medicine. (2019). Guidelines for the provision of the intensive care services.; Available from: https://www.ficm.ac.uk/news-eventseducation/ news/guidelines-provision-intensive-care-services-gpics-%E2%80%93-secondedition.
24. Alhazzani, W., … Hayden, F., Evans, L., and Rhodes, A., (2019). Surviving sepsis campaign: Guidelines of the Management of Critically Ill Adults with Coronavirus Disease (COVID- 19). Critical Care Medicine, 2020. EPub Ahead of Print.
25. World Health Organization, (2020). Clinical Management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected Interim Guidance, 2020. p. WHO Reference number WHO/2019-nCoV/clinical/4.
26. Metro North, (2020). Interim infection prevention and control guidelines for the management of COVID-19 in healthcare settings,: https://www.health.qld.gov.au/ data/assets/pdf_file/0038/939656/qh-covid-19- Infectioncontrol- guidelines.pdf.
27. Stiller, K., (2013). Physiotherapy in intensive care: an updated systematic review. Chest,
144(3): p. 825-847.
28. Green, M., V. Marzano, I.A. Leditschke, I. Mitchell, and B. Bissett, (2016). Mobilization of intensive care patients: a multidisciplinary practical guide for clinicians. J Multidiscipline Health, 9: p. 247-56.
29. Hodgson, C.L. Zanni, L. Denehy, and S.A. (2014). Webb, Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical Care, 2014. 18(6): p. 658.
30. Australian and New Zealand Intensive Care seeliery, ANCS COVID 19 Guidelines 202 ANZICS Melhsore.
31. Zanni, M.J., denehy,L.(2014). Expert consensus and recommendations on safety criteria for active mobilization of mechanically ventilated critically ill adults. Critical care. 18 (6): p 658.