COVID-19 and the hyperferritinemic syndromes

The hyperferritinemic syndromes include macrophage activation syndrome, adult onset Still's disease, catastrophic antiphospholipid syndrome, and septic shock. The syndrome is characterized by life-threatening disease due to the development of a cytokine storm, multiorgan damage, elevated ferritin levels, and the response to similar therapies. In the third phase of SARS-COV2 infection, the hyperinflammatory phase, elevated ferritin levels and the development of a cytokine storm are present. A new entity, multisystem inflammatory syndrome, described predominantly in pediatric patients, mimics MAS, yet develops without a previous symptomatic disease. In these patients, hyperferritinemia is prominent. Elevated ferritin levels in COVID-19 intensive care unit patients predict mortality. Ferritin levels in nonsurvivors are much higher than those who survive. Consecutive measurements of a rising ferritin level may predict the need for assisted ventilation. Treatments such as corticosteroids, biologics, and IVIG may also be beneficial for COVID-19 as they are for the other hyperferritinemic syndromes. In this review, we present proof of concept for COVID-19 to be included with the other entities in the hyperferritinemic syndrome. © 2023 Elsevier Inc. All rights reserved.

COVID-19 and seasonal influenza infection outcomes in the ICU: a retrospective comparison study.

OBJECTIVE: To compare the characteristics and outcomes of critically ill patients admitted to the intensive care unit (ICU) due to COVID-19 or influenza- associated pneumonia. PATIENTS AND METHODS: We conducted a two-center retrospective study on patients admitted to the ICU due to either COVID-19 associated pneumonia (CAP) or influenza-associated pneumonia (IAP). Baseline characteristics, therapy during hospitalization and clinical outcomes were assessed. RESULTS: Our study included 86 patients admitted to the ICU. Twenty-four patients (28%) had IAP and 62 patients (72%) had CAP. Those with IAP had more comorbidities of cardiac disease (p=0.005) and chronic obstructive lung disease (p=0.03) compared to those with CAP. Non-invasive ventilation was used significantly more in patients with IAP (p=0.001). The use of neuromuscular blockade was significantly higher in CAP patients (p=0.001). CAP patients had less favourable ventilation parameters. PEEP was significantly higher in those with CAP on the first day of admission (p=0.002). There was no difference in mortality (p=0.61) between the groups. CONCLUSIONS: Patients admission to the ICU with CAP had less comorbidity than those with IAP. Patients with CAP had poorer ventilatory parameters patterns, requiring more aggressive ventilation and ECMO support. The overall mortality did not differ significantly between the groups.

Awake extracorporeal membrane oxygenation in a patient with COVID-19 pneumonia and severe hypoxemic respiratory failure.

OBJECTIVE: In the past few years, extracorporeal membrane oxygenation (ECMO) has been increasingly used in patients with severe respiratory insufficiency in whom mechanical ventilation (MV) had failed. MV in severe COVID-19 patients is often accompanied by high respiratory pressures and high oxygen concentrations. Thus, by "placing the lungs at rest" ECMO might spare severe COVID-19 patients from being subjected to aggressive MV. Awake ECMO is another therapeutic alternative for providing extracorporeal oxygenation and ventilation by avoiding the complications of MV. CASE PRESENTATION: A 65-year-old male diagnosed with COVID-19 pneumonia was admitted to the intensive care unit (ICU) after deteriorating to hypoxemic respiratory failure with acute respiratory distress disorder (ARDS). Awake veno-venous (VV) ECMO was considered after receiving patient consent and was successfully implemented as an attempt to avoid invasive MV. This is one of the first cases described during the COVID-19 pandemic, in which awake VV-ECMO was used in a critically ill COVID-19 patient as a replacement therapy to conventional MV. CONCLUSIONS: Under the appropriate conditions, awake ECMO might be a suitable alternative approach to avoid complications of aggressive MV in selected critically ill COVID-19 ARDS patients.