My little guy is admitted to the MSU for COVID respiratory issues. So far he has had 2 Rac Epi treatments and 2 doses of decadron. Currently on 6-7L of high flow oxygen (HFNC). Still breathing in the 40s/min, he is 18 months old. The team mentioned remdesivir, which I am hesitant of considering how new it is and the lack of numerous trials. They have started some vitamins well, D & C, apparently Thaimine is on backorder. Any other suggestions you guys are seeing? Other antivirals? His breath sounds have been more stridor/croup, less wheezing. No chest x-ray yet either. Open to all thoughts, suggestions.
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Any Pedi Docs want to chime in?
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Last: 2 yr ago by wsteed311
I am a nurse but hope this helps. I was just looking through the clinical pathway that CHOP has posted. They are one of the best childrens hospitals in the country. So sorry your guy is sick. Does your son have RSV also? Racemic Epi and decadron are both upper airway medications. Some tachypnea is expected with croup or upper airway illnesses. How are his sats? What day of illness is this? Take a look at the link and in particular click on the "review of therapies by illness." I am not good at posting a picture. Hope this helps.
https://www.chop.edu/clinical-pathway/covid-disease-therapies-severity-illness
https://www.chop.edu/clinical-pathway/covid-disease-therapies-severity-illness
No on RSV, just COVID. I am surprised so many are pushing remdesivir considering it is brand new and has an 11 percent occurrence of an AKI. I have read some studies showing solu-medrol being more effective than decadron but it wasn't specific on pediatrics. The docs here are saying croup seems to be more frequent with this current strand of COVID.
Also, this is day 3 of illness, sats are 100 percent on the HFNC and he went all last night with no O2 need. Back on the O2 as of this AM, mainly to help with his work of breathing.
I don't think I would do the remdesivir on a child that young. Prayers to your child and to you and your family.
wsteed311 said:
No on RSV, just COVID. I am surprised so many are pushing remdesivir considering it is brand new and has an 11 percent occurrence of an AKI. I have read some studies showing solu-medrol being more effective than decadron but it wasn't specific on pediatrics. The docs here are saying croup seems to be more frequent with this current strand of COVID.
It looks like CHOP would also be hesitant to give a toddler Remdesivir.
Where is KidDoc?
https://i.postimg.cc/rpHKr9JQ/IMG-0770.jpg
I haven't done intensive care stuff in a long time but I agree with the rest I would be hesitant on Remdesivir. With the primarily laryngeal inflammation decadron is usually more effective relative to corticosteroids like salu-medrol. Honestly it sounds like he has stabilized and should turn the corner in the next day or so.
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I hope your little guy is doing better now. In case it helps, my 3-year-old had croup during his covid infection and had trouble breathing as a result. Standard dose of steroids did the trick for him. He recovered very quickly afterwards.
Hope he is doing well?
2nd pushing the docs for high doses of steroids.
I had remdisvir when I had covid. May have saved my life but personally the kidney complications are not something I would try on someone younger.
I felt that I did not get better after the 5 days and it was the steroids that finally got me over the hill.
Please let us know how he is.
2nd pushing the docs for high doses of steroids.
I had remdisvir when I had covid. May have saved my life but personally the kidney complications are not something I would try on someone younger.
I felt that I did not get better after the 5 days and it was the steroids that finally got me over the hill.
Please let us know how he is.
Sorry I never closed the loop here. He did great. Just needed about 3 days of weaning O2 and steroids. Did not end up taking the remdesivir. Thanks to all for the replies!