Blood Purification in Severe and Critical COVID-19 Patients: A Case Series of 5 Patients

Objective: The ongoing coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to a worldwide pandemic. Currently, supportive care measures remain the standard of care for severe and critical COVID-19 patients, such as ventilation oxygenation, fluid management and blood purification. In this study, we aimed to evaluate the effects of early blood purification therapy upon severe and/or critical COVID-19 patients.Patients and Methods: From January 31, 2020 to March 1, 2020, a total 5 patients with COVID-19 (3 critical type cases and 2 severe type cases) received early blood purification treatment in the intensive care unit (ICU) of Affiliated Hospital of Zunyi Medical University. Clinical indexes, including oxygen concentration, blood gas analysis, oxygenation index, and laboratory test as well as disease scores were recorded and analyzed before and after the treatment with blood purification.Results: Among the 5 patients, 4 were males ranging from 35 to 80 year old (Mean age = 63 ± 17.87). All cases with characteristics of OI <300 mm Hg, decline in lymphocyte (LYMPH)%, boost in lactate dehydrogenase (LDH), troponin T (TNT), B-type brain natriuretic peptide (BNP), interleukin-6 (IL-6) and interferon-alpha (IFN-a), three with high flow nasal cannula (HFNC), two with non-invasive ventilation (NIV) and acute kidney injury (AKI), and one with shock and IV. Blood purification therapy significantly decreased the serum levels of inflammatory cytokine, ameliorated the concomitant symptoms and complications. Finally, one case was discharged from the hospital, 4 cases were transferred to the general ward, and all the 5 cases survived.Conclusion: Continuous blood purification therapy held promising prospects for alleviating the deteriorative progression of severe and critical types of COVID-19 in the early stage, together with ameliorating the accumulation of inflammatory cytokine and the concomitant symptoms and complications by efficacious immunoadsorption.Trial Registration:www.chictr.org.cn, Identifier (ChiCTR2000031930).

Use of extracorporeal blood purification therapy (ECBPT) as an adjuvant to high-dose corticosteroids in a severely ill COVID-19 patient with concomitant bacterial infection

COVID-19 presents with a spectrum of severity, ranging from asymptomatic or mild symptoms to those with acute respiratory distress syndrome. Corticosteroids are widely used for their efficacy in reducing inflammatory responses. However, its use may be limited to patients with immunosuppression. An adjunct therapy for cytokine storm in COVID-19 is extracorporeal blood purification therapies using high adsorptive filters, such as oXiris, to remove cytokines. We share our experience in using continuous renal replacement therapy with oXiris haemofilter as a temporising measure to high-dose corticosteroids in managing cytokine storm in a deteriorating COVID-19 patient with concomitant bacterial infection.

Case Series: Efficacy and Safety of Hemoadsorption With HA-330 Adsorber in Septic Pediatric Patients With Cancer

Background: Sepsis is a frequent cause of death in hospitalized patients and, in detail, in neonatal, pediatric, and adult intensive care units (ICUs). Severe sepsis has a very poor prognosis. Indeed, the mortality rate varies between 30 and 70% during the first 7–14 days. Despite a timely and appropriate therapy, the prognosis of severe sepsis is too often negative. Therefore, new therapeutic resources are under investigation in order to further improve prognosis.Case series: Here, we reported three septic children in whom we used extracorporeal blood purification therapy with hemoadsorption device HA330 (Jafron Biomedical Co., Ltd., China), aiming to scavenge and eliminate bacterial toxins and inflammatory mediators from the blood.Discussion and Conclusion: This small case series first showed that hemoperfusion with HA330 cartridge may be an effective and relatively safe adjunctive treatment to counterbalance the cytokine storm in septic children with hematological disorders. Further studies are needed to confirm and further support its safety and efficacy in a large number of pediatric patients.

Application of extracorporeal carbon dioxide removal combined with continuous blood purification therapy in ARDS with hypercapnia in patients with critical COVID-19

INTRODUCTION: Coronavirus disease-19 (COVID-19) is a new type of epidemic pneumonia caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The population is generally susceptible to COVID-19, which mainly causes lung injury. Some cases may develop severe acute respiratory distress syndrome (ARDS). Currently, ARDS treatment is mainly mechanical ventilation, but mechanical ventilation often causes ventilator-induced lung injury (VILI) accompanied by hypercapnia in 14% of patients. Extracorporeal carbon dioxide removal (ECCO2R) can remove carbon dioxide from the blood of patients with ARDS, correct the respiratory acidosis, reduce the tidal volume and airway pressure, and reduce the incidence of VILI. CASE REPORT: Two patients with critical COVID-19 combined with multiple organ failure undertook mechanical ventilation and suffered from hypercapnia. ECCO2R, combined with continuous renal replacement therapy (CRRT), was conducted concomitantly. In both cases (No. 1 and 2), the tidal volume and positive end-expiratory pressure (PEEP) were down-regulated before the treatment and at 1.5 hours, one day, three days, five days, eight days, and ten days after the treatment, together with a noticeable decrease in PCO2 and clear increase in PO2, while FiO2 decreased to approximately 40%. In case No 2, compared with the condition before treatment, the PCO2 decreased significantly with down-regulation in the tidal volume and PEEP and improvement in the pulmonary edema and ARDS after the treatment. CONCLUSION: ECCO2R combined with continuous blood purification therapy in patients with COVID-19 who are criti-cally ill and have ARDS and hypercapnia might gain both time and opportunity in the treatment, down-regulate the ventilator parameters, reduce the incidence of VILI and achieve favorable therapeutic outcomes.

Hybrid Blood Purification Therapy Based on Camel Nanoantibody Immunoadsorbent on Patients with Chronic Renal Failure in Nephrology Department

This paper proposes a study on the effect of hybrid blood purification therapy based on camel nanoantibody immunoadsorbent on chronic renal failure patients in nephrology department. In this paper, the hybrid blood purification therapy based on camel nanoantibody immunoadsorbent was applied to patients with chronic renal failure, and the curative effect of the patients was studied. In order to highlight the effect, a control group was set up for comparison. In this paper, the clearance effect of small molecule toxin, middle molecular toxin, and dialysis adequacy was analyzed. This study found that the average dialysis adequacy of the control group was 1.23% and that of the experimental group was 1.26%. The dialysis adequacy of the experimental group was significantly better than that of the control group. In addition, the clearance effect of small and medium molecular toxins in the experimental group was significantly better than that in the control group. It can be seen that the hybrid blood purification therapy based on camel nanoantibody immunoadsorbent is effective in the treatment of chronic renal failure patients in the department of nephrology. Therefore, it is of great value to apply camel nanoantibody in the clinical treatment of renal failure.

Controlling Cytokine Storm Is Vital in COVID-19

Corona virus disease 2019 (COVID-19) has caused a global outbreak and severely posed threat to people’s health and social stability. Mounting evidence suggests that immunopathological changes, including diminished lymphocytes and elevated cytokines, are important drivers of disease progression and death in coronavirus infections. Cytokine storm not only limits further spread of virus in the body but also induces secondary tissue damage through the secretion of large amounts of active mediators and inflammatory factors. It has been determined that cytokine storm is a major cause of deaths in COVID-19; therefore, in order to reverse the deterioration of severe and critically ill patients from this disease, the cytokine storm has become a key therapeutic target. Although specific mechanisms of the occurrences of cytokine storms in COVID-19 have not been fully illuminated, hyper-activated innate immune responses, and dysregulation of ACE2 (angiotensin converting enzyme 2) expression and its downstream pathways might provide possibilities. Tailored immunoregulatory therapies have been applied to counteract cytokine storms, such as inhibition of cytokines, corticosteroids, blood purification therapy, and mesenchymal stem cell therapy. This review will summarize advances in the research of cytokine storms induced by COVID-19, as well as potential intervention strategies to control cytokine storms.

SARS-CoV-2-Related Kidney Injury: Current Concern and Challenges

Coronavirus disease 2019 (COVID-19) not only causes pulmonary inflammation but also causes multiple organ damages, including the kidney. ACE2, as one of the receptors for SARS-CoV-2 intrusion, is widely distributed in kidney tissues. Currently, the diagnosis and treatment of SARS-CoV-2 infection in patients with chronic kidney disease (CKD) are still unclear. Here, we review the recent findings of characteristics of COVID-19 in CKD patients and highlight the possible mechanisms of kidney injury caused by SARS-CoV-2 infection. We then discuss the emerging therapeutic approaches aimed at reducing kidney damage and protecting kidney function including virus removal, immunotherapy, supporting treatment, special blood purification therapy, etc. Problems unresolved and challenges ahead are also discussed.

A search in the surge of treatment for COVID-19 patients: A narrative literature review

Today, our understanding towards COVID-19 pandemic is that it is contagious and based on the of the virus, the signs and symptoms of this viral resemble the viral infectionlike Severe Acute-Respiratory (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV). Currently, documented vaccines or drugs are not available for the treatment of COVID-19, SARS-CoV-2 viral infection. The main objective of this article is to compile the available literature on the treatment modalities for COVID-19, currently being advocated. Furthermore, there is no time to wait for evidence-based treatment, hence in such a scenario; an attempt has been made to collect the available scientific literature and understand the treatment of the disease with this insight. A MEDLINE-PUBMED search was performed in the surge of the treatment strategies for COVID-19 using the keywords "COVID-19", "", "novel ", "treatment of " and "therapies". We have reviewed the multiple articles from recently published literature and various proofs from up-to-date journals. Based on the reviewed literature, various categories of drugs are under trial or have been tried for the treatment of infection, which are as medications (anti-viral agents, and , ACE-2 inhibitors, etc.), immune therapy, traditional Chinese medicine, plasma exchange therapy, and blood purification therapy, etc. We attempted to go through the literature available for the treatment of COVID-19 and tried to compile it all together. Still, clinical trials are under process, and there are no evidence-based treatment strategies available to manage the cases of COVID-19 patients.