Protracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report

Kyo, Michihito; Yonemitsu, Takafumi; Tanaka, Rikako; Nakashima, Tsuyoshi; Shibata, Mami; Funahashi, Ryosuke; Yamasaki, Kazuhiko; Yamada, Mario; Tamoto, Kaori; Akamatsu, Keiichiro; Nishio, Machiko; Yamaue, Hiroki; Kato, Seiya

doi:10.1002/ams2.521

Cited by 6 publications

(4 citation statements)

References 11 publications

(17 reference statements)

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“…The defining clinical characteristic of the SARS-COV2 epidemic has been respiratory failure, with profound hypoxemia leading to mechanical ventilation and overwhelmed intensive care units. 27 While patients typically present meeting criteria for acute respiratory distress syndrome (ARDS), COVID-19 respiratory failure appears to be distinct in so far as it is steroid responsive, 28 venous thromboembolism is common 29,30 the course is protracted 31 and there may be distinct phenotypes characterized by differing lung compliance. 17,32 While clinicians have been advised to manage COVID-19 patients based on the existing paradigm for ARDS, 23 these differences point to a different disease process, and the need to re-evaluate treatment strategies that are both established for ARDS and those that may be less frequently used as rescue therapies.…”

Section: Discussionmentioning

confidence: 99%

Responsiveness of Inhaled Epoprostenol in Respiratory Failure due to COVID-19

Sonti

Pike

Cobb

2020

J Intensive Care Med

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Background: Inhaled pulmonary vasodilators are used as adjunctive therapies for the treatment of refractory hypoxemia. Available evidence suggest they improve oxygenation in a subset of patients without changing long-term trajectory. Given the differences in respiratory failure due to COVID-19 and “traditional” ARDS, we sought to identify their physiologic impact. Methods: This is a retrospective observational study of patients mechanically ventilated for COVID-19, from the ICUs of 2 tertiary care centers, who received inhaled epoprostenol (iEpo) for the management of hypoxemia. The primary outcome is change in PaO2/FiO2. Additionally, we measured several patient level features to predict iEpo responsiveness (or lack thereof). Results: Eighty patients with laboratory confirmed SARS-CoV2 received iEpo while mechanically ventilated and had PaO2/FiO2 measured before and after. The median PaO2/FiO2 prior to receiving iEpo was 92 mmHg and interquartile range (74 – 122). The median change in PaO2/FiO2 was 9 mmHg (-9 – 37) corresponding to a 10% improvement (-8 – 41). Fifty-percent (40 / 80) met our a priori definition of a clinically significant improvement in PaO2/FiO2 (increase in 10% from the baseline value). Prone position and lower PaO2/FiO2 when iEpo was started predicted a more robust response, which held after multivariate adjustment. For proned individuals, improvement in PaO2/FiO2 was 14 mmHg (-6 to 45) vs. 3 mmHg (-11 – 20), p = 0.04 for supine individuals; for those with severe ARDS (PaO2/FiO2 < 100, n = 49) the median improvement was 16 mmHg (-2 – 46). Conclusion: Fifty percent of patients have a clinically significant improvement in PaO2/FiO2 after the initiation of iEpo. This suggests it is worth trying as a rescue therapy; although generally the benefit was modest with a wide variability. Those who were prone and had lower PaO2/FiO2 were more likely to respond.

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Section: Discussionmentioning

confidence: 99%

Responsiveness of Inhaled Epoprostenol in Respiratory Failure due to COVID-19

Sonti

Pike

Cobb

2020

J Intensive Care Med

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“…With some precautions, prone positioning is used in the management of COVID-19related ARDS in pregnant women (24). A case report from Japan suggests that, although prone positioning may mitigate hypoxemia, its role in reducing mortality in COVID-19 patients with ARDS is unclear, particularly in patients with a secondary superinfection (25), which is often associated with sepsis, shock, and multiple organ failure (26).…”

Section: Introductionmentioning

confidence: 99%

Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

Team

Jones³

et al. 2021

Front. Med.

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Coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was identified in China in December 2019 and became a pandemic in a short period of time. While most infected people might have mild symptoms, older people and people with chronic illnesses may develop acute respiratory distress syndrome (ARDS). Patients with ARDS with worsening hypoxemia require prone positioning to improve the respiratory mechanics and oxygenation. Intubated patients may stay in a prone position up to 12–16 h, increasing the risk of pressure injury (PI). Frequent skin inspections and PI risk assessment in COVID-19 patients will be challenging due to hospital infection control measures aimed to reduce the risk for health professionals. In this perspective article, we summarize the best practice recommendations for prevention of PI in SARS-CoV-2-infected ARDS patients in prone positioning. Prior to positioning patients in prone position, the main recommendations are to (1) conduct a skin assessment, (2) use pressure redistribution devices, (3) select an appropriate mattress or an overlay, (4) ensure that the endotracheal tube securing device is removed and the endotracheal tube is secured with tapes, (5) use a liquid film-forming protective dressing, and (6) lubricate the eyes and tape them closed. Once a patient is in prone position, it is recommended to (1) use the swimmer's position, (2) reposition the patient every 2 h, and (3) keep the skin clean. When the patient is repositioned to supine position, healthcare professionals are advised to (1) assess the pressure points and (2) promote early mobilization.

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“…A 79-year-old man was admitted to our intensive care unit with respiratory failure due to COVID-19. After a 16-day course of invasive mechanical ventilation, he died due to multiple organ failure ( 10 ). Three days before death, we obtained a computed tomography scan of his lungs, which revealed worsening consolidation in the lower lungs and ground glass opacification in the upper lungs.…”

Section: Methodsmentioning

confidence: 99%

Immune Cells Profiles in the Different Sites of COVID-19-Affected Lung Lobes in a Single Patient

et al. 2022

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Whereas the COVID-19 disease pathophysiology is under investigation, it is important to identify the pathways of viral transmission and inflammation from the pre-illness to the disease-onset stages. We analyzed five lung lobes from a patient with COVID-19 who finally died after prolonged lung protective ventilation. Pathological examination revealed moderate inflammation in upper lung lobes and uneven yet severe inflammation and diffuse alveolar damage in lower lung lobes. SARS-CoV-2 was detected at higher levels not in severely, but rather moderately inflamed middle lung lobes, and immunohistochemistry and bulk RNA-sequencing results showed that immune cells were detected at higher levels in lower lung lobes. The mRNA expression of cytokine families varied. We found an increase in keratin 5- or aquaporin 3-expressing basal cells in the severely inflamed lower lung lobes, and the alveolar stromal tissues were filled with them. Thus, this analysis of lung samples from a patient helps to determine the COVID-19 pathophysiology at a specific time point, and the virus localization and inflammatory responses at each site of the lungs provide various important indications.

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Protracted course of coronavirus disease with severe acute respiratory distress syndrome: a case report

Cited by 6 publications

References 11 publications

Responsiveness of Inhaled Epoprostenol in Respiratory Failure due to COVID-19

Responsiveness of Inhaled Epoprostenol in Respiratory Failure due to COVID-19

Pressure Injury Prevention in COVID-19 Patients With Acute Respiratory Distress Syndrome

Immune Cells Profiles in the Different Sites of COVID-19-Affected Lung Lobes in a Single Patient

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