Mild disease Picture compatible with upper airway infection, without signs of dehydration, dyspnea, sepsis, or organ dysfunction. The most common signs and symptoms are fever, cough, difficulty breathing, sore throat, nasal congestion, headache, malaise, and myalgia. Immunosuppressed, the elderly and children may have atypical conditions and show no signs of dehydration, fever, or difficulty breathing. In pregnant women, due to physiological adaptations or adverse events in pregnancy, dyspnoea, fever, gastrointestinal symptoms or fatigue may overlap with Covid-19 symptoms.
Pneumonia without complications Adult infection of the lower respiratory tract without signs of severity. A child without signs of severe pneumonia with cough or difficulty breathing and rapid breathing. Observation: Follow the respiratory rate reference values according to the age range for evaluation: *respiratory incursions per minute (ripm). 1 to 12 months: 30 to 53 ripm 1 to 2 years: 22 to 37 ripm 3 to 5 years: 20 to 28 ripm School: 18 to 25 ripm Adolescent: 12 to 20 ripm
Severe pneumonia Adolescent or adult: lower respiratory tract infection with any of the following signs of severity described below: respiratory rate> 30 incursions per minute; severe respiratory effort; SpO2 <93% in room air; cyanosis; organic dysfunction. Children with a cough or difficulty breathing more than at least one of the following criteria: central cyanosis or spO2 <90%; severe respiratory effort; signs of PNM with aspects of severity (use of accessory muscles for breathing; inability or refusal to breastfeed or drink fluids; wheezing or stridor at rest; unavoidable vomiting; altered sensory: irritability or drowsiness; convulsions). The respiratory rate that denotes severity in children will depend on age, namely: <2 months: ≥60 ripm 2 to 11 months: ≥50 ripm 1 to 5 years: ≥40 ripm The diagnosis is clinical. Chest images can identify or exclude complications.
Acute respiratory distress syndrome (ARDS) Onset or worsening of respiratory symptoms, up to one week after the onset of the disease. It may also present: radiological changes (infiltrates, bilateral opacities, lobar/pulmonary atelectasis, or nodules); pulmonary edema not explained by heart failure or hyperhydration. Oxygenation impairment in adults and children: ADULTS: Lightweight: 200 mmHg <PaO2 / FiO2 ≤ 300 mmHg (with Peep or Cpap ≥ 5 cm H2O, or not ventilated). Moderate Sara: 100 mmHg <PaO2 / FiO2 ≤ 200 mmHg (with PEEP ≥ 5 cm H2O, or not ventilated). Severe Sara: PaO2 / FiO2 ≤ 100 mmHg (with PEEP ≥ 5 cm H2O, or not ventilated). When PaO2 is not available, SpO2 / FiO2 ≤ 315 suggests Sara (including in unventilated patients). CHILDREN: OI = Oxygenation Index and OIU = Oxygenation Index using SpO2. Use the PaO2 based metric, when available. If PaO2 is not available, wean FiO2 to maintain SpO2 ≤ 97% to calculate OSI or SpO2 / FiO2 ratio: Non-invasive ventilation or Cpap bi-level ≥ 5 cm H2O through a full face mask: PaO2 / FiO2 ≤ 300 mmHg or SpO2 / FiO2 ≤ 264. Light Sara (with invasive ventilation): 4 ≤ OI <8 or 5 ≤ OSI <7.5. Moderate Sara (with invasive ventilation): 8 ≤ OI <16 or 7.5 ≤ OIU <12.3. Severe condition (with invasive ventilation): OI ≥ 16 or OIU ≥ 12.3.
Sepsis Systemic inflammatory response syndrome with organ dysfunction in the presence of presumed or confirmed infection. Frequent signs of organ dysfunction are altered level of consciousness, oliguria, tachy and/or dyspnoea, low oxygen saturation, tachycardia, weak pulse, cold extremities, coagulopathy, thrombocytopenia, acidosis, elevated serum lactate or bilirubin.
Septic shock Sepsis accompanied by hypotension [mean arterial pressure (MAP) <65 mmHg] despite adequate volume resuscitation and requiring the use of vasopressors to maintain MAP> = 65 mmHg. Children: any type of hypotension (SBP <5th percentile or> 2 SD below normal for age) or two or three of the following: altered mental status; tachycardia or bradycardia (HR <90 bpm or> 160 bpm in children under 12 months and HR <70 bpm or> 150 bpm in children); prolonged capillary filling (> 2 sec) or weak pulse; tachypnea; stained or cold skin or petechial or purple rash; increased lactate; oliguria; hyperthermia or hypothermia.