Efficacy of therapeutic plasma exchange in the treatment of penn class 3 and 4 cytokine release syndrome complicating COVID-19
| Autor: | Julie C. Martin, Robert A. Brevetta, Sean P. Callahan, Wesley M. Smith, W Larry Gluck, W Jeffery Edenfield, Antine E. Stenbit, Anna V. Blenda, Sergio Arce |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine Oxygenation index Critical Illness medicine.medical_treatment Pilot Projects Respiratory failure Severity of Illness Index Therapeutic plasma exchange Cytokine release syndrome Therapeutic benefit Severity of illness medicine Humans Prospective Studies Prospective cohort study Original Research Plasma Exchange SARS-CoV-2 business.industry Oxygen Inhalation Therapy COVID-19 Oxygenation Middle Aged medicine.disease Respiration Artificial Cytokine Anesthesia Room air distribution Female Respiratory Insufficiency business |
| Zdroj: | Respiratory Medicine |
| ISSN: | 0954-6111 |
| DOI: | 10.1016/j.rmed.2020.106188 |
| Popis: | Objectives Cytokine release syndrome (CRS) is a potentially severe complication of COVID-19 most commonly resulting in respiratory failure. This ten-patient study was designed to determine the efficacy of therapeutic plasma exchange (TPE) in improving oxygenation and in reducing the cytokine load in a critically ill subset of patients. Methods Five single volume plasma exchanges over eight days within a 14-day study period. In mechanically ventilated patients, oxygenation was measured via the PaO2/FiO2 (P/F) ratio and the oxygenation index (OI) daily for 14 days. Supplemental oxygen requirements were tracked daily for non-ventilated patients. Results Non-ventilated patients were liberated from supplemental oxygen after TPE. The response was rapid with an 87% average reduction in oxygenation requirements following and average time to return to room air of 5.25 days. All mechanically ventilated patients demonstrated improvement in oxygenation with a 78% average improvement in the P/F ratio and a 43% improvement in OI. C-reactive protein (CRP) and serum levels of IL-6, IL-8, IL-10, TNFα, IFNγ and GM-CSF, were measured daily with immediate post TPE levels drawn on days 1, 2, 4, 6 and 8. All patients demonstrated significant reductions in CRP, IL-6, IL-10 and TNFα. Conclusions In the majority of patients with Penn class 3 and 4 CRS complicating COVID-19, TPE demonstrated a prompt improvement in oxygenation and reduction in cytokine load without compromising patient safety. As this pilot study was envisioned to be hypothesis generating, expanded trials using TPE alone and in conjunction with novel pharmacologic agents are warranted. Registration ClinicalTrials.gov NCT04374149. Highlights • Plasmapheresis can effectively reduce injurious cytokines that complicate COVID-19. • Plasmapheresis can produce clinically meaningful improvement in oxygenation. • Plasmapheresis can be safely used as a treatment for COVID-19 cytokine storm. |
| Databáze: | OpenAIRE |
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