Therapeutic plasma exchange in adult critically ill patients with life-threatening SARS-CoV-2 disease: A pilot study

In the 5 months since initial reports of COVID-19 came to light, the death toll due to SARS-CoV-2 has rapidly increased. The morbidity and mortality of the infection varies based upon patient age, comorbid conditions, viral load, and the availability of effective treatments. Findings from limited autopsies, clinical observations, and laboratory data suggest that high cytokine levels and a procoagulant state can precipitate acute respiratory distress syndrome and multi-organ dysfunction syndrome in critically ill patients. To complicate matters, comorbidities may affect the response to medical treatments currently in use, all of which are still in trial phase. Therapeutic plasma exchange (TPE) merits consideration in the treatment of critically ill COVID-19 patients and is an avenue for clinical trials to pursue. If efficacious, faster recovery of patients may lead to shorter intensive care unit stays and less time on mechanical ventilation. Herein, we briefly discuss some of the various approaches currently being investigated for the treatment of SARS-CoV-2 with a focus on potential benefits of TPE for selected critically ill patients.

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Faculty Opinions recommendation of The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10434956.12607054 ◽

2011 ◽

Author(s):

Bruce Bistrian

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Nutritional Support ◽

Randomized Controlled ◽

Control Study

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Faculty Opinions recommendation of The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.10434956.11266056 ◽

2011 ◽

Author(s):

Nicholas Barrett

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Nutritional Support ◽

Randomized Controlled ◽

Control Study

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Removal of elevated circulating angiopoietin-2 by plasma exchange – A pilot study in critically ill patients with thrombotic microangiopathy and anti-glomerular basement membrane disease

Thrombosis and Haemostasis ◽

10.1160/th10-02-0138 ◽

2010 ◽

Vol 104 (11) ◽

pp. 1038-1043 ◽

Cited By ~ 8

Author(s):

Carsten Hafer ◽

Jan Kielstein ◽

Marion Haubitz ◽

Hermann Haller ◽

Svjetlana Lovric ◽

...

Keyword(s):

Basement Membrane ◽

Plasma Exchange ◽

Critically Ill ◽

Glomerular Basement Membrane ◽

Critically Ill Patients ◽

Plasma Levels ◽

Vascular Inflammation ◽

Endothelial Damage ◽

Healthy Controls ◽

Angiopoietin 2

SummaryIn critically ill patients, the massive release of angiopoietin-2 (Ang-2) from Weibel-Palade bodies interferes with protective angiopoietin-1 (Ang-1)/Tie2 signalling in endothelial cells, thus leading to vascular inflammation and subsequent organ-dysfunction. We hypothesised that plasma exchange (PE) is efficient for lowering excess Ang-2 levels in critically ill patients with thrombocytic microangiopathy (TMA) or anti-glomerular basement membrane (anti-GBM) disease. Plasma Ang-1 and Ang-2 were measured by immuno-luminometric assays in patients with TMA (n=9) or anti-GBM disease (n=4) before and after up to four PE sessions. Twenty apparently healthy volunteers served as controls. Median (IQR) plasma levels of Ang-2 were markedly increased in patients with TMA (7.3 (2.4–21.1) ng/ml) and anti-GBM disease (5.8 (3.4–7.0) ng/ml) compared to healthy controls (1.0 (0.9–1.4) ng/ml, p <0.001). Moreover, Ang-1 plasma levels were decreased in both, TMA (1.02 (0.62–1.62) ng/ml) and anti-GBM disease patients (0.74 (0.59–3.62) ng/ml) compared to healthy controls (2.5 (1.93–3.47) ng/ ml, p <0.005). During a total of 32 treatments, PE effectively lowered elevated mean (SD) Ang-2 plasma levels by 36.7 ± 19.6 % per treatment (p <0.0001), whereas low Ang-1 plasma levels remained unchanged (0.3 ± 58.5 %; p =0.147). Ang-2 levels declined to almost normal values during ≤4 PE treatments (Friedman´s test p <0.0001). PE is an effective method to remove excess circulating Ang-2. It remains to be elucidated if the removal of Ang-2 is crucial to ameliorate endothelial damage in critically ill patients with severely altered endothelial integrity.

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Measurement of serial serum total and acylated ghrelin levels in critically ill patients: A prospective and observational pilot study

Nutrition in Clinical Practice ◽

10.1002/ncp.10681 ◽

2021 ◽

Author(s):

Zahide Karaca ◽

Recep C. Yuksel ◽

Gulsah Gunes Sahin ◽

Neslihan Sungur ◽

Sahin Temel ◽

...

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Acylated Ghrelin ◽

Serial Serum

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The Efficacy of Convalescent Plasma Use in Critically Ill COVID-19 Patients

Medicina ◽

10.3390/medicina57030257 ◽

2021 ◽

Vol 57 (3) ◽

pp. 257

Author(s):

Livius Tirnea ◽

Felix Bratosin ◽

Iulia Vidican ◽

Bianca Cerbu ◽

Mirela Turaiche ◽

...

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Therapeutic Option ◽

White Blood Cells ◽

The United States ◽

Plasma Therapy ◽

Reactive Protein ◽

United States Food ◽

States Food

Background and Objectives: On 24 March 2020, the United States Food and Drug Administration (FDA) announced the approval of convalescent plasma therapy for critically ill patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as an emergency investigational new drug. This pilot study from Romania aimed to determine if convalescent plasma transfusion can be beneficial in the treatment of selected critically ill patients diagnosed with a SARS-CoV-2 infection. Materials and Methods: Donor and receiver eligibility for critically ill coronavirus disease 2019 (COVID-19) patients was based on Romanian guidelines issued at the time of the study. Here, we describe the evolution of a total of five eligible patients diagnosed with COVID-19 who received convalescent plasma (CP) in Romania. Results: In spite of our efforts and convalescent plasma administration, three of the five patients did not survive, while the other two recovered completely. Over the course of our five-day laboratory record, the surviving patients had significantly lower values for C-reactive protein, interleukin-6, and white blood cells. Conclusions: This pilot study provides insufficient evidence to determine the efficacy of convalescent plasma use as a therapeutic option for critically ill COVID-19 patients.

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Determining rhythmicity and determinism of temperature curves in septic and non-septic critically ill patients through chronobiological and recurrence quantification analysis: a pilot study

Intensive Care Medicine Experimental ◽

10.1186/s40635-019-0267-9 ◽

2019 ◽

Vol 7 (1) ◽

Cited By ~ 2

Author(s):

Vasilios E. Papaioannou ◽

Eleni N. Sertaridou ◽

Ioanna G. Chouvarda ◽

George C. Kolios ◽

Ioannis N. Pneumatikos

Keyword(s):

Pilot Study ◽

Critically Ill ◽

Critically Ill Patients ◽

Recurrence Quantification Analysis ◽

Recurrence Quantification ◽

Quantification Analysis

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Penetration of Isavuconazole in Ascites Fluid of Critically Ill Patients

Journal of Fungi ◽

10.3390/jof7050376 ◽

2021 ◽

Vol 7 (5) ◽

pp. 376

Author(s):

Tobias Lahmer ◽

Gonzalo Batres Baires ◽

Roland M. Schmid ◽

Johannes R. Wiessner ◽

Jörg Ulrich ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Ascites Fluid ◽

Candida Spp ◽

Fungal Peritonitis ◽

Penetration Ratio ◽

Threatening Condition ◽

Liquid Chromatography Tandem Mass ◽

Life Threatening ◽

Fluid Levels

Fungal peritonitis is a life-threatening condition which is not only difficult to diagnose, but also to treat. Following recent guidelines, echinocandins and azoles are the recommended antimycotics for the management of intra-abdominal Candida spp. infections, with a favor for echinocandins in critically ill patients. However, the new extended spectrum triazole isavuconazole also has a broad spectrum against Candida spp. Data on its target-site penetration are sparse. Therefore, we assessed isavuconazole concentrations and penetration ratios in ascites fluid of critically ill patients. Obtaining of Isavuconazole plasma and ascites fluid levels as well penetration ratios using paracentesis in critically ill patients. Isavuconazole concentrations were quantified in human plasma and ascites by a liquid chromatography/tandem mass spectrometry (LC-MS/MS) method. Isavuconazole concentrations in plasma and ascites fluid were measured in sixteen critically ill patients. Isavuconazol levels in ascites fluid (1.06 µg/mL) were lower than plasma levels (3.08 µg/mL). Penetration ratio was 36%. In two out of sixteen patients, Candida spp., in detail C. glabrata and C. tropicalis, could be isolated. Cmax/MIC Ratio in plasma of 560 for C. glabrata and 2166 for C. tropicalis could be observed. Following our results, isavuconazole penetrates into ascites. Successful treatment in Candida spp. peritonitis depends on pathogen susceptibility.

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