Hypoxemia indicative of Rendu Osler disease during SARS Cov-2 pandemic

Rendu Osler’s disease is a genetic disease characterized by mucocutaneous and visceral telangiectasias. Rendu Osler’s disease was discovered during hypoxemia during an outbreak of SARS-Cov2.This was a 36-year-old woman with exertional dyspnea and severe hypoxemia revealing pulmonary arteriovenous malformations on chest CT scan.

498. Baricitinib in Patients with Severe Pneumonia due to COVID-19 in Veracruz, Mexico

Background Patients affected by COVID-19 pneumonia who present severe symptoms with manifest hypoxemia and cytokine storm have a high mortality rate, which is why therapies focused on reducing inflammation and improving lung function have been used, one of them being jakinibs through of the blocking of the JAK tracks. Methods Patients who presented data of severe pneumonia due to COVID-19 with data of severe hypoxemia and cytokine storm were selected, from June to August 2020, to whom the SaO2/FiO2 ratio is measured at the beginning, intermediate and end of treatment, as well as D dimer and serum ferritin. Comorbidity and drugs taken previously are analyzed. The patients being cared for at home. Results We included data from 30 patients, 8 (27%) women and 22 (73%) men, with a median age of 58.5 (46.5 - 68.0) years. 23 patients (77%) had comorbidities, the most frequent being arterial hypertension (43%), followed by obesity (30%), type 2 diabetes mellitus (27%), among others. In the laboratory, the medians of D-Dimer 982 ng/mL, Ferritin 1,375 ng/mL and C-Reactive Protein 10.0 mg/dL. Regarding the use of previous medications, we found that 29 (97%) patients had treatment with some medication, the most frequent: azithromycin (77%), ivermectin (53%) and dexamethasone (47%). The median number of medications received was 3. The initial pulse oximetry (SaO2) measurement with room air had a median of 80.5% and the median SaO2/FiO2 (SAFI) was 134; Regarding the type of SIRA, 90% had moderate SIRA and 10% had severe SIRA. The median day of evolution on which baricitinib was started was 10 days, all received 4 mg/day, and the median days of treatment with baricitinib was 14.0 days. At follow-up, SaO2 at 7 days had a median of 93.0% and the median SAFI at 7 days was 310.0; the median SaO2 at 14 days was 95.0% and the median SAFI at 14 days was 452.0. In comparative analysis, baseline SaO2/SAFI was significantly lower compared to 7 and 14 days (p = 0.001 for both comparisons). The outcomes, 27 (90%) patients improved and there were 3 (10%) who died. Demographic Variables Respiratory Variables Results on SAFI and SaO2 Conclusion Baricitinib therapy in these patients with severe COVID-19 pneumonia who present with severe hypoxemia and cytokine storm presented good results by improving clinical status and pulmonary failure, with patients being cared for at home and avoiding mechanical ventilation. Disclosures All Authors: No reported disclosures

Current Anticoagulation Recommendation for COVID-19 Patients

Thromboembolic events in COVID-19 patients can be one of the factors that aggravate the disease and increase mortality. When severe hypoxemia and hypotension occur in COVID-19 patients, the possibility of embolism should be considered. As a result, anticoagulant therapy in COVID-19 patients has an essential role in lowering disease severity and mortality. Many studies report that giving anticoagulants to COVID-19 patients can reduce mortality. Therefore, it is important to understand the role and use of anticoagulant therapy in cases of COVID-19. Several guidelines that have been issued by several health organizations in the world and Indonesia can be used as guidelines for clinicians to start anticoagulant therapy in cases of COVID-19. Various anticoagulant drug regimens have also been recommended to be used both as prophylaxis and as therapy for thromboembolism that can occur after COVID-19 cases.

Interhospital transfer of COVID-19 patients treated with high-flow nasal oxygen therapy

At the start of the COVID-19 pandemic, early intubation was recommended on the basis of worldwide observations of severe hypoxemia. However, some patients were ultimately able to benefit from high-flow nasal cannula (HFNC) and thus avoid intubation. During the “second wave” (September to December 2020 in France), some emergency departments implemented HFNC in patients with severe COVID-19. The question then arose regarding the transfer of these most serious patients to intensive care units (ICU) and of the respiratory modalities to be used during this transfer. To assess the feasibility of interhospital transfers of COVID-19 patients needing HFNC, we conducted a bi-centric prospective observational study of all medical transfers of patients needing HFNC with the Chambéry and Angers (France) mobile emergency and intensive care service (SMUR) during the “second wave” of the COVID-19 pandemic in France. Analysis of these 42 patients showed no significant variation in the respiratory requirements during the transfer. Overall, 52% of patients were intubated during their stay in ICU, including three patients intubated before or during transfer. Interhospital transfer with HFNC is very high-risk, and intubation remains indicated in the most unstable patients. However, 48% of patients benefited from HFNC and were thus able to avoid intubation during their transfer and ICU stay; for these patients, intubation would probably have been indicated in the absence of available HFNC techniques.