Algoritmo de tratamento

Observe que as formulações/vias e doses podem diferir entre nomes e marcas de medicamentos, formulários de medicamentos ou localidades. As recomendações de tratamento são específicas para os grupos de pacientes:ver aviso legal

Inicial

sepsis of unknown cause

1ª linha – admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

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Inicial
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sepsis of unknown cause
1ª linha – 

admission to intensive care unit (ICU), empiric antimicrobial therapy, and supportive therapy

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[51][66]​​[74]​​​

Empiric antimicrobial therapy for sepsis is appropriate until the diagnosis of HCPS is made. Local protocols and guidelines should be followed. Once the diagnosis is made, antibiotics should be discontinued. See Sepsis in adults and Sepsis in children.

Analgesia and antipyretics may be given while awaiting confirmation of diagnosis.

associado a – infection prevention and control

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Inicial
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sepsis of unknown cause
associado a – 

infection prevention and control

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Standard precautions are recommended when managing all patients with hantavirus infection.[55]​[56] 

Human-to-human transmission has been reported rarely with Andes virus (ANDV). If ANDV infection is suspected or confirmed, the patient should be placed in an isolation room, and contact and airborne precautions are recommended including use of a gown, eye protection, and a N95 (or higher-level) respirator when entering the patient’s room. Duration of precautions should be determined on a case-by-case basis in conjunction with local public health authorities.[6]​[57] 

AGUDA

confirmed hantavirus infection

1ª linha – intensive supportive care

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AGUDA
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confirmed hantavirus infection
1ª linha – 

intensive supportive care

Hantavirus cardiopulmonary syndrome (HCPS) can progress rapidly to cardiogenic shock and death and must be managed in an ICU.[51][66]​​[74]

If empiric antibiotics were started, they may be discontinued once a diagnosis of hantavirus infection is made.

Supplemental oxygen and intubation and mechanical ventilation for respiratory support may be required.[74]​ About 40% of patients admitted to the hospital will not require intubation and can be managed with supplemental oxygen and careful fluid administration.[10] Intubated survivors can usually be extubated within 1 week.[10]

Fluids should be given cautiously so as not to accelerate the development of pulmonary edema.[74]

Vasoactive agents may be required for cardiogenic shock. Dobutamine plus norepinephrine (noradrenaline) has been suggested as an effective regimen.[64][74]​ Dose should be started low and titrated according to response. Consult your local protocols for guidance on choice of regimen and dose.

Platelet transfusion may be required according to local protocols.[74]

Experimental therapies may be used during outbreaks.

associado a – infection prevention and control

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AGUDA
|
confirmed hantavirus infection
associado a – 

infection prevention and control

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Standard precautions are recommended when managing all patients with hantavirus infection.[55]​[56] 

Human-to-human transmission has been reported rarely with Andes virus (ANDV). If ANDV infection is suspected or confirmed, the patient should be placed in an isolation room, and contact and airborne precautions are recommended including use of a gown, eye protection, and a N95 (or higher-level) respirator when entering the patient’s room. Duration of precautions should be determined on a case-by-case basis in conjunction with local public health authorities.[6]​[57]

Considerar – extracorporeal membrane oxygenation (ECMO)

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AGUDA
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confirmed hantavirus infection
Considerar – 

extracorporeal membrane oxygenation (ECMO)

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Early consideration of transfer to a center with ECMO access is key. A falling cardiac index with evidence of cardiovascular collapse is an indication for ECMO support.[64]

Studies suggest that up to 72% of hantavirus cardiopulmonary syndrome (HCPS) patients with high mortality risk supported with ECMO have survived to hospital discharge.[64][82]

Features indicating high mortality risk include: a cardiac index <2.5 L/minute/m²; serum lactate >4 mmol/L; cardiac arrhythmia (ventricular fibrillation, tachycardia, or pulseless electrical dissociation); shock refractory to fluids; and vasoactive therapy.[73]

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Observe que as formulações/vias e doses podem diferir entre nomes e marcas de medicamentos, formulários de medicamentos ou localidades. As recomendações de tratamento são específicas para os grupos de pacientes. Ver aviso legal

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