Tocilizumab Initiation based on Indicator in Patients Infected by Coronavirus-19 to Prevent Intubation

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic has created severe medical and economic consequences worldwide since 2019. Tocilizumab is one of the therapies considered capable of improving the condition of patients with COVID-19. However, there is not much information about the best time to give tocilizumab. METHOD(S): This was an analytical study with a retrospective cohort design, using the data of 125 patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with signs of acute respiratory distress syndrome in Dr. Moewardi Hospital, Surakarta, from March to August 2020. We analyzed various available clinical data to see which factors into clinical improvement with tocilizumab therapy. RESULT(S): Most patients showed clinical improvement after administration of tocilizumab. During the follow-up period, 21 patients died despite tocilizumab therapy. Significant risk factors associated with the need for intubation were heart rate, neutrophil, lymphocyte, pH, PaCO2, and PO2. The most influential variable on the need for intubation without being associated with other risk factors was PaO2 (p = 0.003, Confidence Intervals 95%). CONCLUSION(S): Tocilizumab has a role in treating patients infected by SARS-CoV-2, preventing the need for intubation when given to patients in good saturation condition with oxygen supplementation without positive pressure (PaO2 >65mmHg;SpO2 >93%).Copyright © 2023 Septian Adi Permana, Adhrie Sugiarto, Sidharta Kusuma Manggala, Muhammad Husni Thamrin, Purwoko Purwoko, Handayu Ganitafuri.

Hemoperfusion that was popular during the COVID-19 pandemic: A case series

The medical world has been seeking solutions in solving the Coronavirus disease 2019 (COVID-19) outbreak since 2019. Amongst several alter-natives, hemoperfusion therapy has been reported to be beneficial for alleviating symptoms and reducing mortality in severely ill COVID-19 patients. Hemoperfusion is a process of filtering blood to eliminate toxins and inflammatory factors from the body. This case series aims to high-light the unexpected adverse clinical and labora-tory outcomes in the majority of COVID-19 patients treated with hemoperfusion in our hospi-tal. We included fifteen patients admitted to the Intensive Care Unit (ICU) with moderate-to-se-vere COVID-19 between August and December 2020 and were all given two to four sessions of hemoperfusion using the MG150 cartridge. All ten men and five women showed no improve-ment in their neutrophil-lymphocyte ratio (NLR), ferritin, D-dimer, and C-reactive protein (CRP) values after the hemoperfusion regiments, both survivors and non-survivors. In addition, eleven out of twelve patients with respiratory failure who were then intubated resulted in death. Based on our findings and previous evi-dence, we recommended only performing hemoperfusion for investigational instead of therapeutic purposes due to its poorly under-stood pathophysiology in COVID-19. We also recommended further research regarding the us-age of hemoperfusion in COVID-19 patients, es-pecially in the matter of determining the best time to start the therapy.Copyright © 2023, The Indonesian Foundation of Critical Care Medicine. All rights reserved.

Mortality Rate of COVID‐19 Patients in Intensive Care Unit: A Multicentre Retrospective Observational Study

The case of Coronavirus Disease 2019 (COVID-19) is growing rapidly worldwide. More than 6 million people in Indonesia were confirmed to be infected as of March 2022. This disease caused an increase in the demand of respiratory assistance and intensive care services back in 2021. Unfortunately, the report about COVID-19 case in Intensive Care Unit (ICU) of Indonesia is very scarce although it is very crucial to evaluate the treatment approach and the prognosis of the patients. This study aimed to determine the characteristics, therapy, and outcomes of critically ill COVID-19 patients treated in the ICU. This was a multicentre retrospective study conducted in 12 hospitals in Indonesia from April 2020 to March 2021. All data regarding the characteristics, therapy, and outcomes of COVID-19 patients admitted to ICU were recorded and analysed. 1,502 patients were included in this study. Inpatient mortality occurred in 44.67% patients. The highest morbidity is attributed to stroke (83.4%). We found a significantly longer duration of mechanical ventilation use in non-survivors group (5.57 vs. 1.74 hours). Furthermore, the results of this study showed a significant difference in all type of treatment (excluding antifungal) between two groups. The mortality of COVID-19 patients in ICU is considerably high. Hypothyroidism and DMIІ patients showed a high serum asprosin, which linked with poor glycemic and lipid management. It is a biomarker for diabetes and thyroid issues. © 2023 by SPC (Sami Publishing Company)

High flow nasal cannula to prevent intubation in obese patient with COVID-19 induced ARDS: a case report

Obese patients have been identified to have a poor prognosis and a higher risk of death from coronavirus disease-2019 (COVID-19). We present reports of two obese patients infected with COVID-19 with acute respiratory distress syndrome (ARDS) who showed improvement with high flow nasal cannula (HFNC). HFNC is a noninvasive oxygen delivery device which is capable of delivering a high concentration of oxygen that can reduce the requirement for tracheal intubation. HFNC is convenient to use, can reduce dyspnea without effecting the length of stay in ICU in these cases;and has a high merit to be used in selected patients requiring oxygen before attempting intubation and mechanical ventilation.

A promising therapy of tocilizumab and helmet CPAP to prevent intubation for COVID-19 induced severe ARDS: a case report

A 59 yrs old male with severe ARDS due to COVID-19 infection was in life threatening 'cytokine storm'. He had also co-morbids including diabetes mellitus and hypertension. He had come from Grobogan, a red area for COVID-19. Clinical finding indicted systemic inflammatory response syndrome (SIRS) with dyspnea, tachycardia, and high fever. Laboratory tests showed raised leukocyte count, CRP, SGOT/SGPT, blood sugar, PCT, low PaO2/FiO(2) ratio. RT PCR showed he was infected by COVID-19. Sputum culture showed Klebsiella infection and CXR showed bilateral pneumonia. Patient was treated with standard therapy and a combination of tocilizumab for cytokine-storm and helmet CPAP for severe ARDS. Helmet CPAP has become the first modality for COVID-19 ARDS in some countries but not in Indonesia. We chose helmet CPAP because of the cost efficient, comfortable, and easy operation compared to other modality. We chose tocilizumab because it uses a single dose. Although it is expensive, only one dose is enough and it is effective in blocking the cytokine storm. We found that helmet CPAP and tocilizumab combination in COVID-19 lead severe ARDS could be promising to prevent intubation for patients.