1. Expert Consensus Statements on the Use of Corticosteroids in Non-severe COVID-19
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Vijay Hadda, Rohit Yadav, Ravi Jain, Rajesh M Shetty, Dhruva Chaudhry, Sandeep Garg, Srinivas Samavedam, Deepak Govil, Mohan Gurjar, Prashant Nasa, Sumit Ray, Rajesh C Mishra, Bharat G Jagiasi, Deven Juneja, Mradul Kumar Daga, Manish Munjal, Pradeep Rangappa, Hrishikesh Jha, Himadri S Barthakur, Sivakumar Mundilipayalam Nandakumar, Akshaykumar A Chhallani, Apoorv Krishna, Raghunath Aladakatti, and Yash Javeri
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Thorax ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,business.industry ,medicine.drug_class ,Non-severe COVID-19 ,SARS-CoV-2 ,education ,Organ dysfunction ,Delphi method ,Consensus Statement ,Corticosteroids in moderate COVID-19 ,Critical Care and Intensive Care Medicine ,Delphi study ,Work of breathing ,Radiological weapon ,Internal medicine ,Medicine ,Corticosteroid ,medicine.symptom ,business ,Dexamethasone ,medicine.drug - 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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- 2021