Monitoring of viral load by RT-PCR caused decision making to continue ECMO therapy for a patient with COVID-19.
J Infect Chemother
; 26(12): 1324-1327, 2020 Dec.
Article
in English
| MEDLINE | ID: covidwho-723195
ABSTRACT
Most patients with coronavirus disease 2019 (COVID-19) have just only mild symptoms, but about 5% are very severe. Although extracorporeal membranous oxygenation (ECMO) is sometimes used in critically patients with COVID-19, ECMO is only an adjunct, not the main treatment. If the patient's condition deteriorates and it is determined to be irreversible, it is necessary to decide to stop ECMO. A 54-year-old man was admitted on day 6 of onset with a chief complaint of high fever and cough. Computed tomography (CT) showed a ground glass opacity in both lungs, and reverse transcription-polymerase chain reaction (RT-PCR) diagnosed COVID-19. He was admitted to the hospital and started to receive oxygen and favipiravir. After that, his respiratory condition deteriorated, and he was intubated and ventilated on day 9 of onset, and ECMO was introduced on day 12. Two days after the introduction of ECMO, C-reactive protein (CRP) increased, chest X-p showed no improvement in pneumonia, and PaO2/FiO2 decreased again. As D-dimer rose and found a blood clot in the ECMO circuit, we had to decide whether to replace the circuit and continue with ECMO or stop ECMO. At this time, the viral load by RT-PCR was drastically reduced to about 1/1750. We decided to continue ECMO therapy and replaced the circuit. The patient's respiratory status subsequently improved and ECMO was stopped on day 21 of onset. In conclusion, viral load measurement by RT-PCR may be one of the indicators for promoting the treatment of severe COVID-19 patients.
Keywords
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Main subject:
Pneumonia, Viral
/
Extracorporeal Membrane Oxygenation
/
Coronavirus Infections
/
Viral Load
/
Betacoronavirus
Type of study:
Case report
/
Diagnostic study
/
Prognostic study
Limits:
Humans
/
Male
/
Middle aged
Language:
English
Journal:
J Infect Chemother
Journal subject:
Microbiology
/
Drug Therapy
Year:
2020
Document Type:
Article
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