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Covid-19-Related Severe Heterogeneous Acute Respiratory Distress Syndrome: A Therapeutic Challenge Publisher



Jamaati H1 ; Fadaizadeh L2 ; Khoundabi B3 ; Hashemian S1 ; Monjazabi F4 ; Jahangirifard A1 ; Beigmohammadi M5 ; Farzanegan B6 ; Shojaei S7 ; Tabarsi P8 ; Dastan F1, 9 ; Reza Nadji S10 ; Toutkaboni M11 ; Malekmohammad M6 Show All Authors
Authors
  1. Jamaati H1
  2. Fadaizadeh L2
  3. Khoundabi B3
  4. Hashemian S1
  5. Monjazabi F4
  6. Jahangirifard A1
  7. Beigmohammadi M5
  8. Farzanegan B6
  9. Shojaei S7
  10. Tabarsi P8
  11. Dastan F1, 9
  12. Reza Nadji S10
  13. Toutkaboni M11
  14. Malekmohammad M6
  15. Mohamadnia A1
  16. Mortaz E12
  17. Mirenayat M13
  18. Yassari F14
  19. Heshmatnia J14
  20. Eslaminejad A1
  21. Velayati A15

Source: Biomedical and Biotechnology Research Journal Published:2020


Abstract

Background: A heterogeneous pattern was detected in COVID-19 severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to define special features and individualized treatment modalities for this fatal infectious disease. Methods: Thirty-six patients diagnosed as COVID-19 severe ARDS were chosen. Lung mechanics (compliance), the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), and serum concentrations of immunology markers (interleukin [IL]-1β, IL-6, IL-8, ferritin, and C-reactive protein) were measured. Accordingly, individualized treatment consisting of Actemra, hemoperfusion (HP), continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) was implemented for each patient. Results: Patients were categorized according to the lung compliance: 18 in 'L type' with compliance >40 cc/cmH2O and 18 in 'H type' with compliance ≤40 cc/cmH2O. In 16 patients, standard mechanical ventilation management and antiviral therapy were unsuccessful; therefore, hemodynamic and immunity responses were evaluated. Results of transpulmonary thermodilution in L-type patients surprisingly showed EVLWI = 8.8 ± 1.3 (6.9-9.7) and PVPI = 2.4 ± 0.1 (2.2-2.6). In the H-type patients, five cases showed EVLWI = 8.7 ± 0.8 (7.5-9.8) and PVPI = 2.6 ± 0.3 (2.1-2.8) which were subclassified as 'Ha type' and five cases with EVLWI = 17.5 ± 1.9 (15.7-20.6) and PVPI = 3.9 ± 0.4 (3.5-4.5) were named 'Hb type'. By measuring immunologic markers, these two groups were subdivided into high and low marker groups. Individualized treatment resulted in 2 survivals with Actemra, 1 with HP, 2 with HP + CRRT, and 1 with ECMO. Conclusion: According to the heterogeneity of COVID-19 severe ARDS presentation, which is due to various immunologic and hemodynamic responses, a systematic approach is an important and relatively successful strategy in choosing the appropriate treatment modality. © 2020 Medknow.
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