Recovery of COVID-19 acute respiratory distress syndrome with tocilizumab: successful outcome in two critically ill patients

Background: Severe pneumonia and acute respiratory distress syndrome (ARDS) due to COVID-19 is a challenge for nowadays medical practice. Although there is no clarity in the principal mechanism of lung damage and ARDS development, it has been suggested that one of the main reasons of this pathology is the hyperactivation of the immune system, better known as cytokine storm syndrome. Tocilizumab has been proposed to treat COVID-19 severe cases associated to ARDS. Results & methodology: Here we present two successful cases of tocilizumab administration in two COVID-19 patients with prior administration of antiviral therapy (hydroxychloroquine, azithromycin, lopinavir and ritonavir) with adequate response and resolution of ARDS, septic shock and severe pneumonia within the first 72 h. Discussion & conclusion: This case supports the usage of tocilizumab as an effective therapy in COVID-19 associated cytokine storm syndrome. Further studies should be done in order to assess its effectiveness and security.

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Prophylactic and Therapeutic Administration of Leutragin Increases the Survival Rate of Animals in a Model of Fatal Acute Respiratory Distress Syndrome

Biomeditsina ◽

10.33647/2074-5982-16-4-44-51 ◽

2020 ◽

Vol 16 (4) ◽

pp. 44-51

Author(s):

V. N. Karkischenko ◽

I. A. Pomytkin ◽

M. T. Gasanov ◽

M. S. Nesterov ◽

Yu. V. Fokin ◽

...

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Survival Rate ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Opioid Peptide ◽

Lung Damage ◽

Cytokine Storm ◽

Risk Of Death ◽

Treatment And Prevention

This study aims to investigate effects of leutragin, an opioid peptide analogue of endogenous dynorphin 1-6, on animal survival in an experimental model of “cytokine storm” and fatal acute respiratory distress syndrome (ARDS) in C57Bl/6Y mice under different administration regimens. The aforementioned factors cause a severe course of COVID-19, which explains the current interest in seeking new treatments for ARDS. It was shown that both the prophylactic (before ARDS induction) and therapeutic (after ARDS induction) administration of leutragin in a combined mode — intramuscular injection plus inhalation leads to a statistically signiﬁcant increase in the survival rate of animals. Compared to the control, leutragin signiﬁcantly reduced the risk of death in animals with ARDS. The discovered prophylactic effect of leutragin deserves special attention due to its potential in preventing the onset of the disease and impeding the development of severe lung damage, thus reducing the risk of ARDS and fatal outcomes. Thus, the use of leutragin can be seen as a new effective approach to the treatment and prevention of respiratory diseases associated with a “cytokine storm” and ARDS, including the coronavirus infection COVID-19.

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Nitric oxide and interval hypoxic training in COVID-19 rehabilitation— new research direction

Fizioterapevt (Physiotherapist) ◽

10.33920/med-14-2108-04 ◽

2021 ◽

pp. 30-41

Author(s):

Tatyana Nikolaevna Tsyganova ◽

Egor Egorov ◽

Tamara Nikolaevna Voronina

Keyword(s):

Nitric Oxide ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Viral Infection ◽

Distress Syndrome ◽

The Body ◽

Lung Damage ◽

Specific Method ◽

Hypoxic Training

COVID-19, a disease caused by the novel coronavirus SARS-CoV-2, primarily affects lung tissue and disrupts gas exchange, leading to acute respiratory distress syndrome, systemic hypoxia, and lung damage. The search for methods of prevention and rehabilitation, especially after suffering from pneumonia caused by COVID-19, is on the agenda. This article discusses the possibilities of the interval hypoxic training (IHT) method for preventing infections by initiating nitric oxide production in the body. One of the main effects of IHT is the balanced stimulation of nitric oxide (NO) secretion. Over the past two decades, there has been an increasing interest in the function of nitric oxide (NO) in the human body. Nitric oxide plays a key role in maintaining normal vascular function and regulating inflammatory processes, including those leading to lung damage and the development of acute respiratory distress syndrome (ARDS). Our immune system destroys bacteria and viruses by oxidative burst, i.e. when oxygen accumulates inside the cell. This process also involves nitric oxide, a signaling molecule that has an antibacterial and antiviral effect, as well as regulates vascular tone and affects the permeability of the cell wall. Interval hypoxytherapy enhances endogenous oxidative protection and increases the amount of nitric oxide, thus allowing the body’s cells to resist infection more effectively. Mitochondrial NOS induction and mitochondrial NO synthesis increase under the action of pathogenic factors on the cell. By modulating the activity of mtNOS and the synthesis of mitochondrial NO, it is possible to increase the resistance to hypoxic effects. Interval hypo-hyperoxic training as an effective non-specific method of increasing the body’s defenses is indispensable not only in the prevention of viral infection, but also in rehabilitation after viral pneumonia, as well as as a method that reduces the severity of viral infection in the event of infection.

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Surfactant therapy in combination treatment of COVID-19 related acute respiratory distress syndrome

Remedium Journal about the Russian market of medicines and medical equipment ◽

10.21518/1561-5936-2021-1-50-56 ◽

2021 ◽

pp. 50-56

Author(s):

Renat R. Gubaidullin ◽

◽

Aleksandr P. Kuzin ◽

Vladimir V. Kulakov ◽

◽

...

Keyword(s):

Mechanical Ventilation ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Standard Therapy ◽

Distress Syndrome ◽

Severe Pneumonia ◽

Lung Ventilation ◽

Surfactant Therapy

ntroduction. The COVID-19 pandemic caused an outbreak of viral lung infections with severe acute respiratory syndrome complicated with acute respiratory failure. Despite the fact that the pandemic has a lengthened run, none of the therapeutic approaches have proved to be sufficiently effective according to the evidence-based criteria. We consider the use of surfactant therapy in patients with severe viral pneumonia and acute respiratory distress syndrome (ARDS) as one of the possible methods for treating COVID-19 related pneumonia. Objective. To prove the clinical efficacy and safety of orally inhaled Surfactant-BL, an authorized drug, in the combination therapy of COVID-19 related ARDS. Materials and methods. A total of 38 patients with COVID-19 related severe pneumonia and ARDS were enrolled in the study. Of these, 20 patients received the standard therapy in accordance with the temporary guidelines for the prevention, diagnosis and treatment of the novel coronavirus infection (COVID-19) of the Ministry of Health of the Russian Federation, version 9. And 18 patients received the surfactant therapy in addition to the standard therapy. Surfactant-BL was used in accordance with the instructions on how to administer the drug for the indication – prevention of the development of acute respiratory distress syndrome. A step-by-step approach to the build-up of the respiratory therapy aggressiveness was used to manage hypoxia. We used oxygen inhalation via a face mask with an oxygen inflow of 5–15 l/min, highflow oxygen therapy via nasal cannulas using Airvo 2 devices, non-invasive lung ventilation, invasive lung ventilation in accordance with the principles of protective mechanical ventilation. Results and discussion. Significant differences in the frequency of transfers to mechanical ventilation, mortality, Intensive Care Unit (ICU) and hospitalization length of stay (p <0.05) were found between the groups. Patients receiving surfactant therapy who required a transfer to mechanical ventilation accounted for 22% of cases, and the mortality rate was 16%. In the group of patients receiving standard therapy without surfactant inhalation 45% were transferred to mechanical ventilation, and 35% died. For patients receiving surfactant therapy, the hospital stay was reduced by 20% on average, and ICU stay by 30%. Conclusion. The inclusion of surfactant therapy in the treatment of COVID-19 related severe pneumonia and ARDS can reduce the progression of respiratory failure, avoid the use of mechanical ventilation, shorten the ICU and hospitalization length of stay, and improve the survival rate of this patient cohort.

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Acute respiratory distress syndrome caused by carbon monoxide poisoning and inhalation injury recovered after extracorporeal membrane oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-021-03023-w ◽

2021 ◽

Vol 15 (1) ◽

Author(s):

Ji Hoon Jang ◽

Hang Jea Jang ◽

Hyun-Kuk Kim ◽

Jin Han Park ◽

Hyo-Jung Kim ◽

...

Keyword(s):

Carbon Monoxide ◽

Acute Respiratory Distress Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Carbon Monoxide Poisoning ◽

Polymyxin B ◽

Inhalation Injury ◽

Cytokine Storm ◽

Direct Hemoperfusion

Abstract Background Inhalation injury from smoke or chemical products and carbon monoxide poisoning are major causes of death in burn patients from fire accidents. Respiratory tract injuries from inhalation injury and carbon monoxide poisoning can lead to acute respiratory distress syndrome and cytokine storm syndrome. In the case of acute respiratory failure needing mechanical ventilation accompanied by cytokine storm, mortality is high and immediate adequate treatment at the emergency department is very important. Case presentation This report describes a case of acute respiratory distress syndrome and cytokine storm followed by carbon monoxide poisoning in a 34-year-old Korean male patient who was in a house fire, and was successfully treated by extracorporeal membrane oxygenation and direct hemoperfusion with polymyxin B-immobilized fiber column at emergency department. Conclusions To prevent mortality in acute respiratory distress syndrome with cytokine storm from inhalation injury and to promote a better prognosis, we suggest that early implication of extracorporeal membranous oxygenation along with direct hemoperfusion with polymyxin B-immobilized fiber column even at the emergency department should be considered.

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Cytokine storm syndrome in SARS-CoV-2: a review

Zeitschrift für Naturforschung C ◽

10.1515/znc-2021-0062 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Braira Wahid ◽

Noshaba Rani ◽

Muhammad Idrees

Keyword(s):

Acute Respiratory Distress Syndrome ◽

Respiratory Failure ◽

Severe Acute Respiratory Syndrome ◽

Respiratory Distress Syndrome ◽

Respiratory Distress ◽

Distress Syndrome ◽

Cytokine Storm ◽

Global Level ◽

Management Option ◽

Human Contact

Abstract After wreaking havoc on a global level with a total of 5,488,825 confirmed cases and 349,095 deaths as of May 2020, severe acute respiratory syndrome coronavirus 2 is truly living up to the expectations of a 21st-century pandemic. Since the major cause of mortality is a respiratory failure from acute respiratory distress syndrome, the only present-day management option is supportive as the transmission relies solely on human-to-human contact. Patients suffering from coronavirus disease 2019 (COVID-19) should be tested for hyper inflammation to screen those for whom immunosuppression can increases chances of survival. As more and more clinical data surfaces, it suggests patients with mild or severe cytokine storms are at greater risk of failing fatally and hence these cytokine storms should be targets for treatment in salvaging COVID-19 patients.

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