At a Glance Commentary: Scientific knowledge on the Subject: severe SARS-CoV-2 infections leading to the Coronavirus disease 2019 (COVID-19) and the acute respiratory distress syndrome (ARDS) are associated with high mortality and prolonged durations of intensive care unit stay. Profound lymphopenia and elevated serum levels of pro-inflammatory cytokines, also characterized as cytokine storm, have been associated with clinical severity. However, few data compared the immunopathology of COVID-19 ARDS to that of non-COVID-19 ARDS, so that specific traits of the immune responses to severe SARS-CoV-2 infections have not been well identified. What This Study Adds to the Field: COVID-19 ARDS patients showed a phenotype of impaired adaptive immune response with profound lymphopenia and impaired/delayed lymphocyte activation. We also report a "chemokine signature" with increased serum concentrations of IP-10 and GM-CSF in COVID-19 patients. Serum concentrations of IP-10 and GM-CSF and nasopharyngeal viral loads were associated with outcomes in COVID-19 patients. Such results highlight the contribution of myeloid cells and impaired adaptive immune

Background Current practices regarding tracheostomy in patients treated with extracorporeal membrane oxygenation (ECMO) for acute respiratory distress syndrome are unknown. Our objectives were to assess the prevalence and the association between the timing of tracheostomy (during or after ECMO weaning) and related complications, sedative, and analgesic use. Methods International, multicenter, retrospective study in four large volume ECMO centers during a 9-year period. Results Of the 1,168 patients treated with ECMO for severe ARDS (age 48 ± 16 years, 76% male, SAPS II score 51 ± 18) during the enrollment period, 353 (30%) and 177 (15%) underwent tracheostomy placement during or after ECMO, respectively. Severe complications were uncommon in both groups. Local bleeding within 24 h of tracheostomy was four times more frequent during ECMO (25 vs 7% after ECMO, p < 0.01). Cumulative sedative consumption decreased more rapidly after the procedure with sedative doses almost negligible 48–72 h later, when tracheostomy was performed after ECMO decannulation (p < 0.01). A significantly increased level of consciousness was observed within 72 h after tracheostomy in the “after ECMO” group, whereas it was unchanged in the “during-ECMO” group. Conclusion In contrast to patients undergoing tracheostomy after ECMO decannulation, tracheostomy during ECMO was neither associated with a decrease in sedation and analgesia levels nor with an increase in the level of consciousness. This finding together with a higher risk of local bleeding in the days following the procedure reinforces the need for a case-by-case discussion on the balance between risks and benefits of tracheotomy when performed during ECMO.

| 897 situations (6), these data suggest that regulatory policy in each country influenced the use of HCQ/CQ for COVID-19.What can we learn from the differing experiences in New Zealand and the US? When potential medications for COVID-19 are proposed for clinical use without RCT evidence of efficacy and safety, strong regulatory action to restrict access circumvents excessive medication dispensing that may cause shortages.

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