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Indian Journal of Critical Care Medicine ; 25(SUPPL 1):S26, 2021.
Article in English | EMBASE | ID: covidwho-1200243


Introduction: Pneumonia with severe respiratory failure represents the principal cause of death in COVID-19, where hyper-inflammation plays an important role in lung damage. An effective treatment aiming at reducing the inflammation without preventing virus clearance is thus urgently needed. Tocilizumab, an anti-IL-6 receptor monoclonal antibody, has been proposed for the treatment of patients with COVID-19. Early use of tocilizumab prevents sudden deterioration of patient but after 15 days cavitary lesions are found in HRCT chest which is manageable. Objectives: To discuss the use of early tocilizumab in severe COVID pneumonia patients. Materials and methods: A 46-year-old Indian man presented in casualty with the complaint of shortness of breath, cough fever since 5 days admitted in COVID ward after COVID-19 RT-PCR tested positive HRCT chest shows 90% lung involvement. The initial patient was vitally stable with SpO2 98 with 15 L oxygen support NRBM, respiratory rate was 18/minute. ABG shows mild hypoxia. On day 2, the patient started deteriorating, not maintaining saturation on NRNM support taking on NIV support. Worsening of blood marker started. We plan for use of early tocilizumab 400 mg. The next day tocilizumab was given. The patient intubated and took on AC/VC support. After 5 days, the patient successfully extubated. On the seventh day, the patient extubate Results: Use of early tocilizumab prevents sudden deterioration of patient with 90% lung involvement but after 20 days cavitary lesions found which is manageable. Discussions: The patient came with severe pneumonia due to COVID. Tocilizumab was given on the third day of admission. The blood marker shows regular improvement. The patient intubated then extubated. Cavitary lesion developed. Oxygen requirement slowly decreases. Bronchoscopy shows normal findings. BAL shows tubercular etiology. ATT started. After 30 days, the patient successfully discharge. Conclusion: Tocilizumab can be beneficial to the suddenly deteriorating patients due to hyperimmune reaction if the timing of administration is right.

Indian Journal of Critical Care Medicine ; 25(SUPPL 1):S6, 2021.
Article in English | EMBASE | ID: covidwho-1200228


Introduction: An inflammatory response to SARS-CoV-2 infection, due to cytokine release syndrome, has been implicated in the pathology of acute respiratory distress syndrome in patients with COVID-19. Baricitinib is a reversible JAK-inhibitor that interrupts the multiple inflammatory cytokines in COVID-19 immunopathology. Objectives: Our aim to study the overall outcome of baricitinib on critical patients with COVID-19. Materials and methods: A cross-sectional study of 10 cases, infected with COVID-19 severe pneumonia and were critically ill. The patient's average ICU stay, CBC, changes in HRCT scans, clinical improvement, cytokine storm markers before and after baricitinib doses were taken into account. Due consent was taken from all patients. Results: Seventy percent of patients showed a reduction in CRP values. In 70% of patients, D-dimer values either decreased or were kept within normal limits. 90% of patients were shifted from NIV support to NRBM within 7 days of baricitinib. 50% of patients showed a rising trend in platelet counts. 70% patients were shifted to ward from ICU 30% patients were discharged within 7 days of Baricitinib. Discussions: Baricitinib is the Janus kinase (JAK) inhibitor, which may prevent cytokine storm in patients with SARS-CoV-2 pneumonia. Conclusion: In our study, baricitinib has shown promising results. It is incumbent on researchers to develop and validate reliable tools to monitor the overall outcome of patients with baricitinib in COVID-19.