High‑flow nasal cannula oxygenation and tocilizumab administration in patients critically ill with COVID‑19: A report of three cases and a literature review

Abstract

Since late 2019, SARS-CoV2 has spread worldwide, leading the WHO to declare a pandemic state. Italy was deeply affected by the virus, particularly North Italy. Several molecules have been tested for the treatment of coronavirus disease (COVID-19), comparing the treatment efficacy and collateral effects. To date, no antiviral drugs have been approved for the treatment of the COVID-19 viral phase or for the inflammatory phase. Undoubtedly, oxygen support plays a key role in the management of patients affected by this virus. The present study reports the cases of 3 patients critically ill with COVID-19. Despite antiviral therapy, their clinical conditions deteriorated a few days following admission, particularly as regards respiratory performance, together with chest X-ray findings and arterial blood gas parameters. The levels of inflammatory markers were also elevated. The patients were treated with high-flow nasal cannula (HFNC) oxygenation along with a double dose of tocilizumab. A few days following HFNC and tocilizumab administration, the respiratory rates and arterial blood gas data were ameliorated along with chest X-ray results. The use of HFNC was then slowly reduced until it was terminated, with the patients achieving a successful discharge. On the whole, as presented herein, it is indisputable more data and guidelines for COVID-19 therapies are warranted in order to guide clinicians as to the appropriate clinical treatment which will guarantee an optimal therapeutic response.

Clinical characteristics and predictors of death among hospitalized patients infected with SARS‑CoV‑2 in Sicily, Italy: A retrospective observational study

“…Furthermore, HFNC has been shown to be associated with a significantly lower risk of bioaerosol dispersion, reducing the risk of hospital-acquired infections for health workers ( 33 ). Case reports and case series have demonstrated how patients may achieve a marked improvement in respiratory function, as well as lower respiratory fatigue, with better results on arterial gas analysis when treated early with HFNC ( 34 , 35 ).…”

Corynebacterium striatum Bacteremia during SARS-CoV2 Infection: Case Report, Literature Review, and Clinical Considerations

“…Overall, although the patient that we presented had no relevant immunosuppression diseases [ 33 , 49 , 50 , 51 ], except for cancer diagnosis, she presumably died due to disseminated intravascular coagulation (CID)-like syndrome caused by septic shock. Despite the SARS-CoV2 infection, the patients did not have any lung involvement; however, we could not definitely rule out viral effects such as hyperinflammation and hypercoagulopathy [ 52 , 53 , 54 ]. Therefore, it is hard to define whether the antibiotic therapy had sufficient time to be effective, or whether the multi-organ failure, caused by bacterial and viral co-infection, led to the exitus before or notwithstanding the opportune therapy [ 55 , 56 ].…”

Pain crisis management in a patient with sickle cell disease during SARS‑CoV‑2 infection: A case report and literature review

“…A higher fatality rate in patients with SCD with COVID-19 has also been reported by Minniti et al (12); however, they revealed that the risk of adverse outcomes in these patients may be reduced by anticoagulant therapy. As a matter of fact, SARS-CoV-2 infection, due to the resulting cytokine storm along with the hypercoagulable state, culminates in an increased risk of thromboembolic events in patients with SCD (13)(14)(15).…”