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Selection of COVID-19 specific therapy in patients who have severe infection requiring O2 supplementation

Selection of COVID-19 specific therapy in patients who have severe infection requiring O2 supplementation
This algorithm covers selection of COVID-19-specific therapy only. Refer to other UpToDate content for discussion of other management issues, including management of hypoxia, prevention of thromboembolism, and management of other complications. The approach to COVID-19-specific therapy in individuals who have no oxygen requirement or who are seen in the outpatient setting is also covered elsewhere.

ECMO: extracorporeal membrane oxygenation; ICU: intensive care unit; CRP: C-reactive protein.

* If dexamethasone is unavailable, other glucocorticoids at equivalent doses are reasonable alternatives.

¶ For those who are stably on minimal supplemental oxygen (eg, 1 to 2 L/min), it is reasonable to forgo dexamethasone and use remdesivir alone, particularly in patients who are immunocompromised and within 10 days of illness onset.

Δ The clinical benefit of remdesivir is uncertain in patients who need support beyond low-flow oxygen, but it is reasonable to use it in those on high-flow or noninvasive ventilation, particularly if they are immunocompromised and receiving immunomodulatory agents for COVID-19.

◊ Tocilizumab and baricitinib should be used with caution in immunocompromised patients, among whom the safety of further immune modulation with such agents is uncertain.
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