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.
[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].
Fonte original da atualizaçãoexternal link opens in a new window
Resumo
Definição
História e exame físico
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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