scholarly journals Corticosteroid therapy for 2019‐nCoV‐infected patients: A case series of eight mechanically ventilated patients

2021 ◽  
Author(s):  
Mabrouk AL‐Rasheedi ◽  
Yasir Alhazmi ◽  
Nouf Almaqwashi ◽  
Alreshidi Mateq Ali ◽  
Abdulaziz Kardam ◽  
...  
Keyword(s):  
Corticosteroid Therapy ◽  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

scholarly journals Corticosteroid therapy for 2019-nCoV infected patients: a case series of 8 mechanically ventilated patients

2021 ◽  
Author(s):  
Mabrouk AL-Rasheedi ◽  
Yasir Alhazmi ◽  
Nouf Almaqwashi ◽  
Mateq Alreshidi ◽  
Abdulaziz Kardam ◽  
...  
Keyword(s):  
Severe Acute Respiratory Syndrome ◽  
Corticosteroid Therapy ◽  
Case Series ◽  
High Dose ◽  
Short Term ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients

Objective To report a series of eight cases of severe acute respiratory syndrome due to 2019-nCoV infection (Covid-19- Bilateral infiltration) who were successfully treated with high-dose short-term corticosteroid therapy.

scholarly journals Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: a case series

2020 ◽  
Vol 26 (1) ◽  
Author(s):  
Andrew G. Weber ◽  
Alice S. Chau ◽  
Mikala Egeblad ◽  
Betsy J. Barnes ◽  
Tobias Janowitz
Keyword(s):  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Dornase Alfa ◽  
Extracellular Traps ◽  
Dnase 1 ◽  
Fraction Of Inspired Oxygen ◽  
Oxygen Requirements ◽  
Inspired Oxygen ◽  
Ventilated Patients

Abstract Background Mechanically ventilated patients with COVID-19 have a mortality of 24–53%, in part due to distal mucopurulent secretions interfering with ventilation. DNA from neutrophil extracellular traps (NETs) contribute to the viscosity of mucopurulent secretions and NETs are found in the serum of COVID-19 patients. Dornase alfa is recombinant human DNase 1 and is used to digest DNA in mucoid sputum. Here, we report a single-center case series where dornase alfa was co-administered with albuterol through an in-line nebulizer system. Methods Demographic and clinical data were collected from the electronic medical records of five mechanically ventilated patients with COVID-19—including three requiring veno-venous extracorporeal membrane oxygenation—treated with nebulized in-line endotracheal dornase alfa and albuterol, between March 31 and April 24, 2020. Data on tolerability and response were analyzed. Results The fraction of inspired oxygen requirements was reduced for all five patients after initiating dornase alfa administration. All patients were successfully extubated, discharged from hospital and remain alive. No drug-associated toxicities were identified. Conclusions Results suggest that dornase alfa will be well-tolerated by patients with severe COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and several have been recently registered.

scholarly journals Nebulized in-line endotracheal dornase alfa and albuterol administered to mechanically ventilated COVID-19 patients: A case series

2020 ◽  
Author(s):  
Andrew G. Weber ◽  
Alice S Chau ◽  
Mikala Egeblad ◽  
Betsy J Barnes ◽  
Tobias Janowitz
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Case Series ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Dornase Alfa ◽  
Link Type ◽  
Inflammatory Status ◽  
Oxygen Requirements ◽  
Ventilated Patients

Background Mechanically ventilated patients with coronavirus disease 2019 (COVID-19) have a mortality of 24-53%, in part due to distal mucopurulent secretions interfering with ventilation. Dornase alfa is recombinant human DNase 1 and digests DNA in mucoid sputum. Nebulized dornase alfa is FDA-approved for cystic fibrosis treatment. DNA from neutrophil extracellular traps (NETs) contributes to the viscosity of mucopurulent secretions. NETs are found in the serum of patients with severe COVID-19, and targeting NETs reduces mortality in animal models of acute respiratory distress syndrome (ARDS). Thus, dornase alfa may be beneficial to patients with severe COVID-19, acting as a mucolytic and targeting NETs. However, delivery of nebulized drugs can aerosolize SARS-CoV-2, which causes COVID-19, increasing the infection risk for staff. Here, we report a single center case series where dornase alfa was administered through an in-line nebulizer system to minimize risk of virus aerosolization. Methods Demographic, clinical data, and outcomes were collected from the electronic medical records of five mechanically ventilated patients with COVID-19, including three requiring veno-venous extracorporeal membrane oxygenation (VV-ECMO), treated with nebulized in-line endotracheal dornase alfa co-administered with albuterol (used to increase delivery to the alveoli), between March 31 and April 24, 2020. Data on tolerability and responses, including longitudinal values capturing respiratory function and inflammatory status, were analyzed. Results Following nebulized in-line administration of dornase alfa with albuterol, the fraction of inspired oxygen requirements was reduced for all five patients. All patients remain alive and two patients have been discharged from the intensive care unit. No drug associated toxicities were identified. Conclusions The results presented in this case series suggest that dornase alfa will be well-tolerated by critically ill patients with COVID-19. Clinical trials are required to formally test the dosing, safety, and efficacy of dornase alfa in COVID-19, and two have recently been registered (NCT04359654 and NCT04355364). With this case series, we hope to contribute to the development of management approaches for critically ill patients with COVID-19.

scholarly journals The Use of Continuous Ketamine for Analgesia and Sedation in Critically Ill Patients with Opioid Abuse: A Case Series

2017 ◽  
Vol 3 (4) ◽  
pp. 148-152 ◽  
Author(s):  
Cierra N. Treu ◽  
Christine M. Groth ◽  
Jignesh H. Patel
Keyword(s):  
Pain Control ◽  
Case Series ◽  
Optimal Dose ◽  
Opioid Therapy ◽  
Opioid Abuse ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ideal Agent ◽  
Unique Mechanism ◽  
Ventilated Patients

Abstract Managing pain and agitation in patients with opioid abuse is becoming more common in intensive care units. Tolerance to commonly used agents is often observed, leading to inadequate pain control and increased agitation. Ketamine’s unique mechanism of action and opioid-sparing effects make it an ideal agent for patients with suboptimal response to opioid therapy. This report describes our experience using continuous ketamine infusions for analgesia and sedation in four mechanically ventilated patients with histories of opioid abuse that had suboptimal response to standard therapy. Ketamine was successful in improving analgesia and sedation in three patients while reducing the need for other analgesics and sedatives with minimal adverse effects. Continuous ketamine infusions may be useful to facilitate mechanical ventilation in patients with histories of opioid abuse with minimal toxicity. More information is needed on the optimal dose and titration parameters.

scholarly journals Pneumothorax in Mechanically Ventilated Patients with COVID-19 Infection

2021 ◽  
Vol 2021 ◽  
pp. 1-8 ◽  
Author(s):  
Raziye Ecem Akdogan ◽  
Turab Mohammed ◽  
Asma Syeda ◽  
Nasheena Jiwa ◽  
Omar Ibrahim ◽  
...  
Keyword(s):  
Case Series ◽  
Fatal Complication ◽  
Bilateral Pneumothorax ◽  
Related Factors ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Factors Associated ◽  
Bilateral Involvement ◽  
Secondary Bacterial Pneumonia ◽  
Ventilated Patients

Data on patient-related factors associated with pneumothorax among critically ill patients with COVID-19 pneumonia is limited. Reports of spontaneous pneumothorax in patients with coronavirus disease 2019 (COVID-19) suggest that the COVID-19 infection could itself cause pneumothorax in addition to the ventilator-induced trauma among mechanically ventilated patients. Here, we report a case series of five mechanically ventilated patients with COVID-19 infection who developed pneumothorax. Consecutive cases of intubated patients in the intensive care unit with the diagnosis of COVID-19 pneumonia and pneumothorax were included. Data on their demographics, preexisting risk factors, laboratory workup, imaging findings, treatment, and survival were collected retrospectively between March and July 2020. Four out of five patients (4/5; 80%) had a bilateral pneumothorax, while one had a unilateral pneumothorax. Of the four patients with bilateral pneumothorax, three (3/4; 75%) had secondary bacterial pneumonia, two had pneumomediastinum and massive subcutaneous emphysema, and one of these two had an additional pneumoperitoneum. A surgical chest tube or pigtail catheter was placed for the management of pneumothorax. Three out of five patients with pneumothorax died (3/5; 60%), and all of them had bilateral involvement. The data from these cases suggest that pneumothorax is a potentially fatal complication of COVID-19 infection. Large prospective studies are needed to study the incidence of pneumothorax and its sequelae in patients with COVID-19 infection.

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