Última revisão: 15 Set 2021
Última atualização: 16 Set 2021
16 Sep 2021

Novidades nesta atualização

NICE atualiza diretriz rápida para COVID-19

  • O National Institute for Health and Care Excellence (NICE) do Reino Unido atualizou sua diretriz rápida de COVID-19 para incluir novas recomendações sobre suporte respiratório não invasivo. O NICE recomenda oferecer pressão positiva contínua nas vias aéreas (CPAP) para os pacientes com hipoxemia que não apresentarem resposta clínica ao oxigênio suplementar, desde que a escalada para ventilação mecânica invasiva seja uma opção, mas não seja imediatamente necessária, ou for acordado que o suporte respiratório não deve ser escalado para além da CPAP.

  • O NICE também atualizou suas recomendações existentes sobre o uso de heparinas. A diretriz agora recomenda uma dose profilática padrão de heparina de baixo peso molecular nos pacientes que necessitarem de oxigênio em sistema de alto fluxo ou de baixo fluxo, CPAP, ventilação não invasiva ou ventilação mecânica invasiva e que não apresentarem aumento do risco de sangramento. Uma dose de tratamento pode ser considerada para aqueles que necessitarem de oxigênio em baixo fluxo e que não apresentarem um aumento do risco de sangramento (recomendação condicional). Doses intermediárias ou de tratamento são recomendadas apenas como parte de um ensaio clínico nas pessoas que recebem oxigênio em sistema de alto fluxo, CPAP, ventilação não invasiva ou ventilação mecânica invasiva.

  • Consulte a seção Algoritmo de tratamento para obter mais informações.

Número de casos de COVID-19 relatados semanalmente por região da OMS e mortes no mundo, até 12 de setembro de 2021[Figure caption and citation for the preceding image starts]: Número de casos de COVID-19 relatados semanalmente por região da OMS e mortes no mundo, até 12 de setembro de 2021World Health Organization [Citation ends].

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Resumo

Definição

História e exame físico

Principais fatores diagnósticos

  • febre
  • tosse
  • dispneia
  • olfato/paladar alterados

Outros fatores diagnósticos

  • fadiga
  • mialgia ou artralgia
  • produção de escarro/expectoração
  • constrição torácica
  • sintomas gastrointestinais
  • faringite
  • cefaleia
  • tontura
  • sintomas neurológicos
  • sintomas oculares
  • rinorreia/congestão nasal
  • sintomas audiovestibulares
  • dor torácica
  • sintomas cutâneos
  • sintomas do trato urinário inferior
  • hemoptise
  • murmúrios brônquicos
  • taquipneia
  • taquicardia
  • cianose
  • estertores na ausculta

Fatores de risco

  • contato com um caso provável ou confirmado
  • residência/trabalho/viagem para local com alto risco de transmissão
  • idade avançada
  • sexo masculino
  • etnia
  • residência em unidade de cuidados de longa permanência
  • presença de comorbidades
  • obesidade
  • doença cardiovascular
  • diabetes
  • doença respiratória crônica
  • doença renal crônica
  • gestação
  • tabagismo
  • neoplasia maligna
  • doença cerebrovascular
  • transplante de órgão sólido ou de células-tronco hematopoiéticas
  • Síndrome de Down ou dificuldade de aprendizagem
  • distúrbios da hemoglobina
  • hipertensão
  • demência
  • imunossupressão
  • Infecção pelo vírus da imunodeficiência humana (HIV)
  • transtornos relacionados ao uso de substâncias
  • crianças com certas condições subjacentes
  • doença hepática crônica
  • deficiência de vitamina D
  • uso de inibidor da bomba de prótons
  • doença autoimune
  • Doença de Parkinson
  • sedentarismo
  • dislipidemia
  • cirurgia
  • grupos sanguíneos A e B
  • disbiose intestinal
  • fatores ambientais

Investigações diagnósticas

Primeiras investigações a serem solicitadas

  • reação em cadeia da polimerase via transcriptase reversa (RT-PCR) em tempo real
  • oximetria de pulso
  • gasometria arterial
  • Hemograma completo
  • perfil metabólico completo
  • testes da função tireoidiana
  • nível glicêmico
  • coagulograma
  • biomarcadores cardíacos
  • proteína C-reativa sérica
  • velocidade de hemossedimentação sérica
  • concentração sérica de lactato desidrogenase
  • nível sérico de interleucina-6
  • procalcitonina sérica
  • nível de ferritina sérica
  • nível de amiloide A sérica
  • creatinoquinase e mioglobina séricas
  • hemoculturas e culturas de escarro
  • radiografia torácica

Investigações a serem consideradas

  • tomografia computadorizada (TC) torácica
  • sorologia
  • teste de antígenos

Novos exames

  • amplificação isotérmica mediada por ciclo de transcrição reversa (RT-LAMP)
  • ultrassonografia do pulmão
  • calprotectina

Algoritmo de tratamento

Colaboradores

Consultores especialistas

Nicholas J. Beeching, MA, BM BCh, FRCP, FRACP, FFTM RCPS (Glasg), FESCMID, DCH, DTM&H

Consultant and Emeritus Professor of Tropical and Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Declarações

NJB is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Tom E. Fletcher, MBE, PhD, MBChB, MRCP, DTM&H

Senior Clinical Lecturer and Defence Consultant in Infectious Diseases

Royal Liverpool University Hospital and Liverpool School of Tropical Medicine

Liverpool

UK

Declarações

TEF is a consultant/expert panel member to the World Health Organization, and is funded by the UK Surgeon General, the NHS, and Liverpool School of Tropical Medicine. TEF is partially supported by the National Institute of Health Research Health Protection Unit (NIHR HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), in collaboration with Liverpool School of Tropical Medicine. He is affiliated with Liverpool School of Tropical Medicine. He has received research grants from the Wellcome Trust, Medical Research Council, and the UK Public Health Rapid Support Team (UK-PHRST). The views expressed are those of the author and not necessarily those of the NHS, the NIHR, the Department of Health, or PHE.

Robert Fowler, MDCM, MS (Epi), FRCP(C)

H. Barrie Fairley Professor of Critical Care

University Health Network and Interdepartmental Division of Critical Care Medicine

Director

Clinical Epidemiology and Health Care Research

Institute of Health Policy, Management and Evaluation

Dalla Lana School of Public Health

University of Toronto

Chief

Tory Trauma Program

Sunnybrook Hospital

Toronto

Canada

Declarações

RF declares that he has no competing interests.

Revisores

William A. Petri, Jr., MD, PhD

Professor

Division of Infectious Diseases and International Health

University of Virginia

Charlottesville

VA

Declarações

WAP declares that he has no competing interests.

Xin Zhang, MD, PhD

Attending Physician

The Fifth Medical Center of PLA General Hospital

Clinical Division and Research Center of Infectious Disease

Beijing

China

Declarações

XZ declares that he has no competing interests.

Ran Nir-Paz, MD

Associate Professor in Medicine

Department of Clinical Microbiology and Infectious Diseases

Hadassah Hebrew University Medical Center

Jerusalem

Israel

Declarações

RNP has received research grants from US-Israel Binational Science Foundation, Hebrew University, Rosetrees Trust, and SpeeDx. He is chair of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group for Mycoplasma and Chlamydia Infections (ESGMAC). RNP is a consultant for and has stocks in eDAS Healthcare. He is also chairperson of the Israeli Society for Infectious Diseases guidelines committee.

Editores

Adam Mitchell,

Section Editor (Infectious Diseases)/Drug Editor, BMJ Best Practice

Declarações

AM declares that he has no competing interests.

Irene Chiwele,

Lead Section Editor, BMJ Best Practice

Declarações

IC declares that she has no competing interests.

Julie Costello,

Comorbidities Editor, BMJ Best Practice

Declarações

JC declares that she has no competing interests.

Consultores especialistas: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Andrew Lewington, BSc (Hons), MBBS, MEd, MD, FRCP

Consultant Renal Physician

Honorary Associate Professor

Nephrology Department

Leeds Teaching Hospitals NHS Trust

Leeds

UK

Declarações

AL is Associate Clinical Director of NIHR Leeds In-Vitro Diagnostics Co-operative, Co-Chair of UK Kidney Research Consortium Renal Clinical Study Group, Member of Kidney Research UK Research Grant Committee, Committee Member of NICE Kidney Injury Clinical Guideline Update 2018-20, Committee Member of NICE Diagnostic Assessment for Point of Care Creatinine Testing 2018-19. AL attended the Acute Dialysis Quality Initiative Meeting in San Diego 2018 (accommodation expenses); AL was a speaker at the AKI & CRRT Conference in San Diego 2019 (travel and accommodation expenses), the AKI Conference in Coventry 2019 (travel expenses), and the NIHR AKI and Sepsis Meeting in Leeds 2019 (no expenses).

Martin Cowie, MD, MSc, FRCP, FRCP (Ed), FESC, FHFA, FACC

Professor of Cardiology

Imperial College London (Royal Brompton Hospital)

London

UK

Declarações

MC is chair of the European Society of Cardiology Digital Health Committee and a trustee of the Atrial Fibrillation Society. He has previously been a non-executive director of the National Institute for Health and Care Excellence. MC provides consultancy advice to AstraZeneca, Servier, Abbott, Medtronic, Boston Scientific, and Genomics PLC. MC declares that none of these interests is directly related to topics advised on for this project.

Rachael Evans, MBChB, FRCP (UK), PhD

Associate Professor (Clinical)

University of Leicester

Honorary Consultant Respiratory Physician

Glenfield Hospital

Leicester

UK

Declarações

RAE has been reimbursed for a GSK Advisory Board meeting on Physical Activity and Asthma in November 2016, and three Chiesi Education meetings for GPs on COPD care in 2019. RAE received a travel award for ERS 2017 from Chiesi and participated in the GSK clinical experience programme - respiratory in August 2018. RAE participated in the BTS/SIGN guidelines for asthma update 2016 (no fee).

Gerry Rayman, MD, FRCP

Consultant Physician and Head of Service

Diabetes and Endocrine Centre and the Diabetes Research Unit

Ipswich Hospitals NHS Trust

Ipswich

UK

Declarações

GR has been paid for advisory board meetings with the following companies: Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Bayer. GR has received lecture fees from Safoni Aventis, Abbott Diabetes UK, Lilly Diabetes, Novonordisk, Napp Pharmaceuticals Ltd.

Sotiris Posporelis, MD, MRCPsych

Consultant Liaison Neuropsychiatrist

King’s College Hospital

South London and Maudsley NHS Foundation Trust

Honorary Senior Clinical Lecturer

Institute of Psychiatry, Psychology & Neuroscience

King’s College London

London

UK

Declarações

SP declares that he has no competing interests.

Acknowledgements,

BMJ Best Practice would like to gratefully acknowledge Dr Matthew Jones for his advice on a section of the stroke comorbidity content.

Matthew Jones, MD, FRCP

Consultant Neurologist

Greater Manchester Neurosciences Centre

Salford Royal Foundation Trust

Honorary Senior Lecturer

University of Manchester

Manchester

UK

Declarações

AA and MJ declare that they have no competing interests.

Revisores: comorbidades

Martyn Patel, BMBcH, FRCP, MA

Consultant, Older People's Medicine

Norfolk and Norwich University Hospitals

NHS Foundation Trust

Norwich

UK

Declarações

MP is a contributor to the Oxford Textbook of Otolaryngology, Oxford University Press, 2021, having written a chapter about mental capacity law, for which he received no fee. MP is the NHS representative on the board for Norwich Institute for Healthy Ageing (unpaid role). MP has spoken at the International Forum on Quality and Safety in Healthcare virtual conference in November 2020, for which he received no fee. MP has accepted speaker fees and/or travel expenses to deliver lectures from: University of East Anglia, Leicester University (speaker fees only); Astellas Pharma Ltd (speaker fees and travel expenses). MP has accepted travel expenses from Newton Europe to present a joint project conducted by his main employer (Norfolk and Norwich University Hospitals NHS Trust) and Newton Europe at the NHS Confederation conference (Manchester 2018).

Asangaedem Akpan, MPH, FRCP

Consultant Geriatrician

Liverpool University Hospitals NHS Foundation Trust

Visiting Professor

University of Cumbria

Carlisle

Honorary Clinical Associate Professor

University of Liverpool

Liverpool

UK

Declarações

AA declares that he has no competing interests.

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