ABSTRACT
The severe acute respiratory coronavirus 2 (SARS-CoV-2), responsible for COVID-19 disease, proved to cause the activation of the innate and adaptive immune system in a small percentage of patients, which resulted in immune dysregulation with massive inflammatory responses and cytokines release. At the same time, complex interactions between SARS-CoV-2 and immune system led to a higher evidence of COVID-19 related autoimmune diseases. In this chapter, we analyze the probable mechanisms of action of high dose intravenous immunoglobulin (IVIg) in the treatment of SARS-CoV-2 infection. We reported evidence in which IVIg proved to be useful in severe COVID-19 disease and in the management of immune dysregulation. Similarly, the use of IVIg was important in the treatment of autoimmune diseases related to COVID-19 and SARS-CoV-2 vaccination. We also discuss the use of convalescent plasma in COVID-19 disease. © 2023 Elsevier Inc. All rights reserved.
ABSTRACT
Introduction: The global pandemic of novel coronavirus disease 2019 (COVID-19) began in Wuhan, China in December 2019 and spread worldwide. This retrospective study summarizes clinical experience and analgo-sedation treatment used for this novel epidemic in an Italian ICU between February to May 2020. Methods: This is a retrospective trial of 72 patients with laboratory-confirmed SARS-CoV-2 infection (COVID-19) admitted to ICU between February15, 2020 and May 15, 2020. Main Outcomes are demographic, clinical data (age, sex, medical comorbidities, respiratory supports, positive end-expiratory pressure values (PEEP), fraction of inspired oxygen (FiO2), arterial partial pressure of oxygen (PaO2), sedatives and analgesic drugs, their dosage and way of administration, medical treatments and patients mortality), ventilation strategies, sedation management in ICUs and patient mortality. Results: The mean age of the 72 patients included in the study was 69 years (SD ±12), 77% were male. All patients required respiratory support and sedation management according to different techniques of ventilation: 100% received deep sedation (RASS-4) before intubation and invasive mechanical ventilation and 19% received light sedation (RASS-1) and noninvasive ventilation). Conclusions: Of the 72 patients admitted in ICUs, 92% died. A total of 608 patients admitted to the AORN dei Colli “Naples” with confirmed COVID-19. In this restrospective study we have analyzed 72 (out of 608) patients that were admitted to intensive care due to worsening clinical conditions. All patients required tracheal intubation and mechanical ventilation with deep sedation (RASS-4), while only 19% (patients required light sedation so RASS-1) were subsequentely swiched to light sedation because of the need of compliance with non-invasive ventilation. Sedation was obtained with propofol, remifentanil, midazolam and dexmedetomidine, according to hospital guidelines. ©2021 The Author(s). Published by MRE Press.