Biomedical and Biotechnology Research Journal (Jan 2020)

COVID-19-Related severe heterogeneous acute respiratory distress syndrome: A therapeutic challenge

  • Hamidreza Jamaati,
  • Lida Fadaizadeh,
  • Batoul Khoundabi,
  • Seyed Mohammad Hashemian,
  • Fatemeh Monjazabi,
  • Alireza Jahangirifard,
  • Mohammad Taghi Beigmohammadi,
  • Behrooz Farzanegan,
  • Seyedpouzhia Shojaei,
  • Payam Tabarsi,
  • Farzaneh Dastan,
  • Seyed Ali Reza Nadji,
  • Mihan Pourabdollah Toutkaboni,
  • Majid Malekmohammad,
  • Abdolreza Mohamadnia,
  • Esmail Mortaz,
  • Maryam Mirenayat,
  • Fatemeh Yassari,
  • Jalal Heshmatnia,
  • Alireza Eslaminejad,
  • Ali Akbar Velayati

DOI
https://doi.org/10.4103/bbrj.bbrj_133_20
Journal volume & issue
Vol. 4, no. 5
pp. 75 – 82

Abstract

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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.

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