Successful treatment of a critically ill patient with acute respiratory distress syndrome from COVID-19 using mechanical ventilation strategy with low levels of positive end-expiratory pressure: A CARE-compliant case report.

INTRODUCTION: Acute respiratory distress syndrome (ARDS) secondary to COVID-19 is different from the ARDS caused by other infections. Conventional mechanical ventilation strategies using high levels of PEEP may not be beneficial and can even be harmful to patient with ARDS from COVID-19. So the ventilation strategies should be adjusted in order to improve the pulmonary ventilation function and oxygenation status, and outcomes of the patient. PATIENT CONCERNS: Herein, we present a 76-year-old male patient with ARDS secondary to COVID-19. We describe our experience with mechanical ventilation strategy and the changes in respiratory mechanics in the patient during treatment. DIAGNOSIS: The patient had tested positive for coronavirus (COVID-19) in nucleic acid test. Chest CT showed multiple ground glass shadows in both lungs. INTERVENTIONS: The patient received mechanical ventilation with low tidal volume and low PEEP. OUTCOMES: After treatment, the patients condition, as well as oxygenation status was improved, and he tested negative for the coronavirus several times. CONCLUSION: This case demonstrated that the low tidal volume with low levels of PEEP ventilation strategy may be more suitable for ARDS from COVID-19.

Intravenous high-dose vitamin C for the treatment of severe COVID-19: study protocol for a multicentre randomised controlled trial.

INTRODUCTION: The rapid worldwide spread of COVID-19 has caused a global health crisis. To date, symptomatic supportive care has been the most common treatment. It has been reported that the mechanism of COVID-19 is related to cytokine storms and subsequent immunogenic damage, especially damage to the endothelium and alveolar membrane. Vitamin C (VC), also known as L-ascorbic acid, has been shown to have antimicrobial and immunomodulatory properties. A high dose of intravenous VC (HIVC) was proven to block several key components of cytokine storms, and HIVC showed safety and varying degrees of efficacy in clinical trials conducted on patients with bacterial-induced sepsis and acute respiratory distress syndrome (ARDS). Therefore, we hypothesise that HIVC could be added to the treatment of ARDS and multiorgan dysfunction related to COVID-19. METHODS AND ANALYSIS: The investigators designed a multicentre prospective randomised placebo-controlled trial that is planned to recruit 308 adults diagnosed with COVID-19 and transferred into the intensive care unit. Participants will randomly receive HIVC diluted in sterile water or placebo for 7 days once enrolled. Patients with a history of VC allergy, end-stage pulmonary disease, advanced malignancy or glucose-6-phosphate dehydrogenase deficiency will be excluded. The primary outcome is ventilation-free days within 28 observational days. This is one of the first clinical trials applying HIVC to treat COVID-19, and it will provide credible efficacy and safety data. We predict that HIVC could suppress cytokine storms caused by COVID-19, help improve pulmonary function and reduce the risk of ARDS of COVID-19. ETHICS AND DISSEMINATION: The study protocol was approved by the Ethics Committee of Zhongnan Hospital of Wuhan University (identifiers: Clinical Ethical Approval No. 2020001). Findings of the trial will be disseminated through peer-reviewed journals and scientific conferences. TRIAL REGISTRATION NUMBER: NCT04264533.