scholarly journals Successful treatment of severe COVID-19 pneumonia and hyperinflammatory syndrome with tocilizumab

2021 ◽  
Vol 14 (1) ◽  
pp. e238210
Author(s):  
Giorgio Gentile ◽  
Rebecca Davies ◽  
Valeria Maria Manfreda ◽  
Zain Ul Abideen
Keyword(s):  
Monoclonal Antibody ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Supportive Treatment ◽  
Invasive Ventilation ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Non Invasive ◽  
The Uk

As of 28 October 2020, there are over 44 000 000 confirmed COVID-19 infections and over 1 000 000 deaths worldwide, including 945 367 infections and 45 765 deaths in the UK. Acute respiratory distress syndrome occurs in 50% of patients with secondary haemophagocytic lymphohistiocytosis, a hyperinflammatory syndrome characterised by a surge of cytokines, including interleukin 6 (IL-6). Here we describe the case of the first patient with severe COVID-19 pneumonia successfully treated with tocilizumab, a humanised monoclonal antibody against the IL-6 receptor, in the UK. Early treatment (after 7–10 days from the onset of symptoms) with tocilizumab could (1) reduce the risk of requiring non-invasive or invasive ventilation; (2) offer a chance of survival to people who are not fit for escalation or have refused to be ventilated; and (3) potentially increase the chance of survival in some patients who are already ventilated but fail to improve with supportive treatment.

Barotrauma during non-invasive ventilation for acute respiratory distress syndrome caused by COVID-19: a balance between risks and benefits

2021 ◽  
Vol 82 (6) ◽  
pp. 1-9
Author(s):  
M Gabrielli ◽  
F Valletta ◽  
F Franceschi ◽  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Acute Respiratory Failure ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Positive Pressure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

Ventilatory support is vital for the management of severe forms of COVID-19. Non-invasive ventilation is often used in patients who do not meet criteria for intubation or when invasive ventilation is not available, especially in a pandemic when resources are limited. Despite non-invasive ventilation providing effective respiratory support for some forms of acute respiratory failure, data about its effectiveness in patients with viral-related pneumonia are inconclusive. Acute respiratory distress syndrome caused by severe acute respiratory syndrome-coronavirus 2 infection causes life-threatening respiratory failure, weakening the lung parenchyma and increasing the risk of barotrauma. Pulmonary barotrauma results from positive pressure ventilation leading to elevated transalveolar pressure, and in turn to alveolar rupture and leakage of air into the extra-alveolar tissue. This article reviews the literature regarding the use of non-invasive ventilation in patients with acute respiratory failure associated with COVID-19 and other epidemic or pandemic viral infections and the related risk of barotrauma.

scholarly journals Comparison of the clinical outcomes of non-invasive ventilation by helmet vs facemask in patients with acute respiratory distress syndrome

Medicine ◽  
2021 ◽  
Vol 100 (4) ◽  
pp. e24443
Author(s):  
Mohamad Y. Khatib ◽  
Mohamed Z. Peediyakkal ◽  
Moustafa S. Elshafei ◽  
Hani S. Elzeer ◽  
Dore C. Ananthegowda ◽  
...  
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Clinical Outcomes ◽  
Distress Syndrome ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation

scholarly journals Positive end expiratory pressure in invasive and non-invasive ventilation of COVID-19 acute respiratory distress syndrome: computational modeling illuminates the data

2021 ◽  
Author(s):  
Liam Weaver ◽  
Declan G. Bates ◽  
Luigi Camporota
Keyword(s):  
Acute Respiratory Distress Syndrome ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Computational Models ◽  
Distress Syndrome ◽  
Lung Protective Ventilation ◽  
Invasive Ventilation ◽  
Positive End Expiratory Pressure ◽  
Non Invasive ◽  
Non Invasive Ventilation

Positive end expiratory pressure (PEEP) is routinely used as part of lung protective ventilation strategies in the treatment of acute respiratory distress syndrome (ARDS). In the case of ARDS arising due to COVID-19 (CARDS), there is some debate as to whether the atypical pathophysiological characteristics of the disease which lead to hypoxaemia could warrant a modified approach to ventilator management, particularly with regards to PEEP settings. Here we review the available evidence for the existence of a unique underlying lung pathophysiology in CARDS, and for the suitability of standard approaches to setting PEEP, in both the invasive and non-invasive ventilation settings. We show how detailed computational models informed by this evidence can shed light on the available data, and help to interpret recent results in the literature.

Does proning on NIV improve oxygenation?

2020 ◽  
Vol 13 (10) ◽  
pp. e235243
Author(s):  
Syed Muhammad Tahir Nasser ◽  
Madan Narayanan
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Distress Syndrome ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Potential Risks

Proning intubated patients with acute respiratory distress syndrome (ARDS) is an established practice to improve oxygenation temporarily. We present two cases of patients on our intensive care unit with ARDS, on non-invasive ventilation (NIV), in whom proning improved oxygenation at a stage when intubation was the next step. We discuss the mechanisms by which proning improves oxygenation as well as the potential risks proning on NIV brings, for which we make specific recommendations.

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