دورية أكاديمية
COVID-19-Related severe heterogeneous acute respiratory distress syndrome: A therapeutic challenge
| العنوان: | COVID-19-Related severe heterogeneous acute respiratory distress syndrome: A therapeutic challenge |
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| المؤلفون: | Hamidreza Jamaati, Lida Fadaizadeh, Batoul Khoundabi, Seyed Mohammad Hashemian, Fatemeh Monjazabi, Alireza Jahangirifard, Mohammad Taghi Beigmohammadi, Behrooz Farzanegan, Seyedpouzhia Shojaei, Payam Tabarsi, Farzaneh Dastan, Seyed Ali Reza Nadji, Mihan Pourabdollah Toutkaboni, Majid Malekmohammad, Abdolreza Mohamadnia, Esmail Mortaz, Maryam Mirenayat, Fatemeh Yassari, Jalal Heshmatnia, Alireza Eslaminejad, Ali Akbar Velayati |
| المصدر: | Biomedical and Biotechnology Research Journal, Vol 4, Iss 5, Pp 75-82 (2020) |
| بيانات النشر: | Wolters Kluwer Medknow Publications, 2020. |
| سنة النشر: | 2020 |
| المجموعة: | LCC:Biotechnology |
| مصطلحات موضوعية: | covid-19, heterogeneity, immunity, severe acute respiratory distress syndrome, thermodilution, Biotechnology, TP248.13-248.65 |
| الوصف: | Background: A heterogeneous pattern was detected in COVID-19 severe acute respiratory distress syndrome (ARDS) patients. The aim of this study was to define special features and individualized treatment modalities for this fatal infectious disease. Methods: Thirty-six patients diagnosed as COVID-19 severe ARDS were chosen. Lung mechanics (compliance), the extravascular lung water index (EVLWI) and pulmonary vascular permeability index (PVPI), and serum concentrations of immunology markers (interleukin [IL]-1β, IL-6, IL-8, ferritin, and C-reactive protein) were measured. Accordingly, individualized treatment consisting of Actemra, hemoperfusion (HP), continuous renal replacement therapy (CRRT), and extracorporeal membrane oxygenation (ECMO) was implemented for each patient. Results: Patients were categorized according to the lung compliance: 18 in “L type” with compliance> 40 cc/cmH2O and 18 in “H type” with compliance ≤40 cc/cmH2O. In 16 patients, standard mechanical ventilation management and antiviral therapy were unsuccessful; therefore, hemodynamic and immunity responses were evaluated. Results of transpulmonary thermodilution in L-type patients surprisingly showed EVLWI = 8.8 ± 1.3 (6.9–9.7) and PVPI = 2.4 ± 0.1 (2.2–2.6). In the H-type patients, five cases showed EVLWI = 8.7 ± 0.8 (7.5–9.8) and PVPI = 2.6 ± 0.3 (2.1–2.8) which were subclassified as “Ha type” and five cases with EVLWI = 17.5 ± 1.9 (15.7–20.6) and PVPI = 3.9 ± 0.4 (3.5–4.5) were named “Hb type”. By measuring immunologic markers, these two groups were subdivided into high and low marker groups. Individualized treatment resulted in 2 survivals with Actemra, 1 with HP, 2 with HP + CRRT, and 1 with ECMO. Conclusion: According to the heterogeneity of COVID-19 severe ARDS presentation, which is due to various immunologic and hemodynamic responses, a systematic approach is an important and relatively successful strategy in choosing the appropriate treatment modality. |
| نوع الوثيقة: | article |
| وصف الملف: | electronic resource |
| اللغة: | English |
| تدمد: | 2588-9834 2588-9842 |
| العلاقة: | http://www.bmbtrj.org/article.asp?issn=2588-9834;year=2020;volume=4;issue=5;spage=75;epage=82;aulast=JamaatiTest; https://doaj.org/toc/2588-9834Test; https://doaj.org/toc/2588-9842Test |
| DOI: | 10.4103/bbrj.bbrj_133_20 |
| الوصول الحر: | https://doaj.org/article/736fa74bec354bee9b6b66a5d20a4308Test |
| رقم الانضمام: | edsdoj.736fa74bec354bee9b6b66a5d20a4308 |
| قاعدة البيانات: | Directory of Open Access Journals |
| تدمد: | 25889834 25889842 |
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| DOI: | 10.4103/bbrj.bbrj_133_20 |