Inpatient Management of COVID-19

Core Treatment Algorithm by Oxygen Requirement

The European Respiratory Society recommends that all hospitalized COVID-19 patients should receive anticoagulation, and those requiring supplemental oxygen or ventilatory support should receive corticosteroids, as these are the only interventions with strong evidence for mortality reduction 1, 2
For patients not requiring supplemental oxygen, the European Respiratory Society suggests supportive care only, with no use of corticosteroids, as there is no mortality benefit and potential harm 1, 3, 4

The European Respiratory Society recommends dexamethasone 6 mg daily for 10 days for patients requiring supplemental oxygen, as it reduces mortality by 3% 5, 2, 4
The European Respiratory Society suggests prophylactic-dose anticoagulation, with low molecular weight heparin (LMWH) preferred over unfractionated heparin, for patients requiring supplemental oxygen 2
The European Respiratory Society recommends high-flow nasal cannula (HFNC) or continuous positive airway pressure (CPAP) for hypoxemic acute respiratory failure without immediate need for intubation 5, 2

The European Respiratory Society suggests adding an IL-6 receptor antagonist, such as tocilizumab or sarilumab, if C-reactive protein (CRP) ≥75 mg/L or other markers of inflammation are present, as it reduces the combined endpoint of mechanical ventilation or death 2, 4

The European Respiratory Society does not recommend routine remdesivir use, and suggests against its use in patients requiring invasive mechanical ventilation, as there is limited and controversial evidence for its effectiveness 1, 3, 4

The European Respiratory Society strongly recommends against the use of hydroxychloroquine, lopinavir-ritonavir, and azithromycin without bacterial coinfection, as they provide no benefit and may cause harm 1, 2, 4

The European Respiratory Society recommends monitoring renal function and platelet counts for anticoagulation decisions, and suggests not changing anticoagulation based solely on D-dimer levels 2
The European Respiratory Society recommends maintaining an oxygen saturation target of no higher than 96% in acute hypoxemic respiratory failure 6

The European Respiratory Society suggests considering anti-SARS-CoV-2 monoclonal antibodies for seronegative patients with moderate-to-severe disease, and high-titer convalescent plasma within 72 hours of symptom onset if monoclonal antibodies are unavailable 7, 4

The European Respiratory Society recommends not delaying intubation if patients fail to respond to HFNC or CPAP within 1-2 hours, and not using corticosteroids in patients not requiring oxygen, as this causes harm without benefit 6, 1, 4
The European Respiratory Society suggests not using remdesivir in mechanically ventilated patients, as there is no survival benefit demonstrated 1, 3

The European Respiratory Society recommends prone positioning for patients receiving invasive ventilation, as it reduces mortality 5
The European Respiratory Society suggests providing psychological support for patients and families experiencing anxiety, fear, or depression, and rehabilitation care as soon as clinically appropriate 4