scholarly journals Corrigendum to: Therapeutics for COVID-19: established and in development

2021 ◽  
Vol 42 (1) ◽  
pp. 46
Author(s):  
Kasha P Singh ◽  
Joe Sasadeusz ◽  
Sharon R Lewin ◽  
Jennifer Audsley
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Distress Syndrome ◽  
Antiviral Agent ◽  
Lung Damage ◽  
Controlled Trials ◽  
Preclinical Development ◽  
Moderate Disease ◽  
Hospitalised Patients

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first recognised in late 2019, with over 30 000 000 cases and over 1 000 000 deaths reported by the end of September 2020. SARS-CoV-2 infection is usually associated with fever, cough, coryza, dyspnoea, anosmia, headache and fatigue and may cause pneumonia and hypoxemia. An excessive/dysregulated inflammatory response may lead to lung damage including acute respiratory distress syndrome (ARDS), coagulopathy and other complications. Mortality amongst hospitalised patients is higher in those needing intensive care. In Australia over 27 000 cases with 882 deaths had been reported by 30 September, most in Victoria. Two therapies have proven beneficial in treatment of hospitalised patients in expedited randomised placebo-controlled trials and are now in widespread use. Dexamethasone improved survival of those requiring respiratory support and the antiviral agent remdesivir decreased time to recovery in mild-moderate disease. Remdesivir was authorised by the Australian Therapeutic Goods Administration in July 2020. Over 200 other therapeutics are being tested for COVID-19 in more than 2000 clinical trials, and many more agents are in preclinical development. We review the evidence for some of the candidates for therapy in COVID-19.

scholarly journals Therapeutics for COVID-19: established and in development

2020 ◽  
Vol 41 (4) ◽  
pp. 217
Author(s):  
Kasha P Singh ◽  
Joe Sasadeusz ◽  
Sharon R Lewin ◽  
Jennifer Audsley
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Distress Syndrome ◽  
Antiviral Agent ◽  
Lung Damage ◽  
Controlled Trials ◽  
Preclinical Development ◽  
Moderate Disease ◽  
Hospitalised Patients

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was first recognised in late 2019, with over 30000000 cases and over 1000000 deaths reported by the end of September 2020. SARS-CoV-2 infection is usually associated with fever, cough, coryza, dyspnoea, anosmia, headache and fatigue and may cause pneumonia and hypoxemia. An excessive/dysregulated inflammatory response may lead to lung damage including acute respiratory distress syndrome (ARDS), coagulopathy and other complications. Mortality amongst hospitalised patients is higher in those needing intensive care. In Australia over 27000 cases with 882 deaths had been reported by 30 September, most in Victoria. Two therapies have proven beneficial in treatment of hospitalised patients in expedited randomised placebo-controlled trials and are now in widespread use. Dexamethasone improved survival of those requiring respiratory support and the antiviral agent remdesivir decreased time to recovery in mild-moderate disease. Remdesivir was authorised by the Australian Therapeutic Goods Administration in July 2020. Over 200 other therapeutics are being tested for COVID-19 in more than 2000 clinical trials, and many more agents are in preclinical development. We review the evidence for some of the candidates for therapy in COVID-19.

scholarly journals Countermeasures to Coronavirus Disease 2019: Are Immunomodulators Rational Treatment Options—A Critical Review of the Evidence

2020 ◽  
Vol 7 (7) ◽  
Author(s):  
Daniel B Chastain ◽  
Tia M Stitt ◽  
Phong T Ly ◽  
Andrés F Henao-Martínez ◽  
Carlos Franco-Paredes ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Respiratory Failure ◽  
Distress Syndrome ◽  
Treatment Options ◽  
Immune Dysregulation ◽  
Lung Damage ◽  
Safety And Efficacy ◽  
Rational Treatment ◽  
Immunomodulatory Therapies

Abstract Severe acute respiratory syndrome coronavirus 2 is associated with higher concentrations of proinflammatory cytokines that lead to lung damage, respiratory failure, and resultant increased mortality. Immunomodulatory therapy has the potential to inhibit cytokines and quell the immune dysregulation. Controversial data found improved oxygenation after treatment with tocilizumab, an interleukin-6 inhibitor, sparking a wave of interest and resultant clinical trials evaluating immunomodulatory therapies. The purpose of this article is to assess potential proinflammatory targets and review the safety and efficacy of immunomodulatory therapies in managing patients with acute respiratory distress syndrome associated with coronavirus disease 2019.

scholarly journals N-acetylcysteine for adults with acute respiratory distress syndrome: A meta-analysis of randomized controlled trials

2019 ◽  
Vol 26 (5) ◽  
pp. 288-298 ◽  
Author(s):  
Xin Lu ◽  
Yong Ma ◽  
Jianqiang He ◽  
Yi Li ◽  
Huadong Zhu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Respiratory Distress ◽  
Intensive Care Unit Stay ◽  
Distress Syndrome ◽  
Meta Analysis ◽  
Controlled Trials ◽  
Randomized Controlled

Background: Acute respiratory distress syndrome is regarded as a formidable clinical challenge due to its high prevalence and mortality. The treatment of acute respiratory distress syndrome is very complex and difficult. As an adjuvant therapy, the antioxidant N-acetylcysteine has been investigated for several years but the benefit is controversial. Objectives: We performed the systematic review and meta-analysis of randomized controlled trials to evaluate the efficacy of N-acetylcysteine on patients with acute respiratory distress syndrome. Methods: We searched PubMed, CENTRAL, and CBM databases. Randomized controlled trials comparing the effects of N-acetylcysteine and control were included. Overall mortality was the primary outcome; length of intensive care unit stay, duration of mechanical ventilation, glutathione levels, and PaO2/FiO2 were the secondary outcomes. Results: Eight trials with a total of 289 patients were included. Compared to the control group, the N-acetylcysteine group did not lower the overall mortality (risk ratio: 0.83; 95% confidence interval: 0.62 to 1.11; P = 0.21; I2 = 0%). However, N-acetylcysteine significantly shortened intensive care unit stay in the random-effects model (mean difference: –4.47 days; 95% confidence interval: –8.79 to −0.14; P = 0.04; I2 = 46%). Due to substantial heterogeneity and limited number of studies, the data of duration of mechanical ventilation, glutathione levels, and PaO2/FiO2 could not be pooled in the meta-analysis. Conclusion: N-acetylcysteine is ineffective in reducing mortality but beneficial for intensive care unit stay. Nonetheless, the effectiveness of N-acetylcysteine for acute respiratory distress syndrome is limited and further research is required before strong recommendations can be made.

Using liquid ventilation to treat patients with acute respiratory distress syndrome: a guide to a breath of fresh liquid

2001 ◽  
Vol 21 (5) ◽  
pp. 55-60 ◽  
Author(s):  
ML Schlicher
Keyword(s):  
Intensive Care Unit ◽  
Clinical Trials ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Lung Diseases ◽  
Distress Syndrome ◽  
Liquid Ventilation ◽  
Phase 3 ◽  
Novel Therapy ◽  
Supportive Management

Research with liquid ventilation indicates that this technology may benefit patients with acute lung diseases such as ARDS. In addition to improving gas exchange, this novel therapy may enhance the delivery of antibiotics and other drugs and thus hasten the recovery from other serious diseases. Additional research on using perflubron in combination with other developing therapies is under way. Clearly, liquid ventilation is not a cure for ARDS. However, it may be helpful in the supportive management of patients with ARDS. As the phase 3 clinical trials are completed, liquid ventilation may become a part of treatment in the intensive care unit. Understanding how liquid ventilation works and knowing what to look for in patients treated with PLV will help ensure better outcomes for patients when this therapy becomes part of clinical practice.

scholarly journals Cardiac biomarkers in acute respiratory distress syndrome: a systematic review and meta-analysis

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Dilip Jayasimhan ◽  
Simon Foster ◽  
Catherina L. Chang ◽  
Robert J. Hancox
Keyword(s):  
Systematic Review ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Cardiac Dysfunction ◽  
Distress Syndrome ◽  
Troponin I ◽  
Meta Analysis ◽  
Cardiac Injury ◽  
Cardiac Biomarkers ◽  
Risk Of Death

Abstract Background Acute respiratory distress syndrome (ARDS) is a leading cause of morbidity and mortality in the intensive care unit. Biochemical markers of cardiac dysfunction are associated with high mortality in many respiratory conditions. The aim of this systematic review is to examine the link between elevated biomarkers of cardiac dysfunction in ARDS and mortality. Methods A systematic review of MEDLINE, EMBASE, Web of Science and CENTRAL databases was performed. We included studies of adult intensive care patients with ARDS that reported the risk of death in relation to a measured biomarker of cardiac dysfunction. The primary outcome of interest was mortality up to 60 days. A random-effects model was used for pooled estimates. Funnel-plot inspection was done to evaluate publication bias; Cochrane chi-square tests and I2 tests were used to assess heterogeneity. Results Twenty-two studies were included in the systematic review and 18 in the meta-analysis. Biomarkers of cardiac stretch included NT-ProBNP (nine studies) and BNP (six studies). Biomarkers of cardiac injury included Troponin-T (two studies), Troponin-I (one study) and High-Sensitivity-Troponin-I (three studies). Three studies assessed multiple cardiac biomarkers. High levels of NT-proBNP and BNP were associated with a higher risk of death up to 60 days (unadjusted OR 8.98; CI 4.15-19.43; p<0.00001). This association persisted after adjustment for age and illness severity. Biomarkers of cardiac injury were also associated with higher mortality, but this association was not statistically significant (unadjusted OR 2.21; CI 0.94-5.16; p= 0.07). Conclusion Biomarkers of cardiac stretch are associated with increased mortality in ARDS.

scholarly journals Collective aeromedical evacuations of SARS-CoV-2-related ARDS patients in a military tactical plane: a retrospective descriptive study

2021 ◽  
pp. bmjmilitary-2021-001876
Author(s):  
Thibault Martinez ◽  
K Simon ◽  
L Lely ◽  
C Nguyen Dac ◽  
M Lefevre ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Acute Respiratory Distress Syndrome ◽  
Intensive Care ◽  
Respiratory Distress Syndrome ◽  
Selection Criteria ◽  
Distress Syndrome ◽  
Descriptive Study ◽  
Military Aircraft ◽  
Life Threatening ◽  
The Military

After the appearance of the COVID-19 pandemic in France, MEROPE system was created to transform the military tactical ATLAS A400M aircraft into a flying intensive care unit. Collective aeromedical evacuations (aero-MEDEVAC) of patients suffering from SARS-CoV-2-related acute respiratory distress syndrome was performed from June to December 2020. A total of 22 patients were transported during seven missions. All aero-MEDEVAC was performed in safe conditions for patients and crew. No life-threatening conditions occurred during flight. Biohazard controls were applied according to French guidelines and prevented crew contamination. Thanks to rigorous selection criteria and continuous in-flight medical care, the safe transportation of these patients was possible. To the best of our knowledge, this is the first description of collective aero-MEDEVAC of these kinds of patients using a tactical military aircraft. We here describe the patient’s characteristics and the flight’s challenges.

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