A case of cytokine hemofiltration and extracorporeal life support as treatment of coronavirus disease 2019 (COVID-19) respiratory failure
| Autor: | Sheila Chucta, Omar Al-Qudsi, Ravi S. Tripathi, Amar Bhatt, Bryan A. Whitson |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Pulmonary and Respiratory Medicine
Mechanical ventilation medicine.medical_specialty ARDS business.industry medicine.medical_treatment 030204 cardiovascular system & hematology medicine.disease_cause medicine.disease Proinflammatory cytokine Hypoxemia 03 medical and health sciences Cytokine release syndrome 0302 clinical medicine 030228 respiratory system Respiratory failure Hemofiltration medicine Surgery medicine.symptom Cardiology and Cardiovascular Medicine Intensive care medicine business Coronavirus |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery |
| ISSN: | 0022-5223 |
| DOI: | 10.1016/j.jtcvs.2020.05.082 |
| Popis: | Background Discovery of the novel severe acute respiratory syndrome coronavirus 2 (n-SARS-CoV-2) in late 2019 has brought with it a renewed interest in methods of inflammatory mitigation, particularly due to reports of a cytokine release syndrome playing a pathogenic role [1]. One method of decreasing inflammation is through hemofiltration in combination with a dialysis membrane that has a large cutoff for protein permeability (high-cutoff/HCO), thereby capturing inflammatory cytokines and attenuating their harmful side effects. The authors report a patient with severe acute respiratory distress syndrome (ARDS) secondary to COVID-19 infection, requiring Veno-Venous Extracorporeal Life Support (VV-ECLS) who was treated with cytokine hemofiltration and showed clinical improvement. Case Summary Our patient is a 53 year-old female who presented with coronavirus infection and respiratory failure culminating in hypoxemia refractory to conventional mechanical ventilation. She was cannulated onto veno-venous extra-corporeal life support and treated with cytokine hemofiltration using a high-cutoff filter. Following treatment, inflammatory markers improved along with compliance and oxygenation. She was decannulated from ECLS shortly thereafter. IRB approval was waived due to the single case report nature. Consent was obtained for use of images and case data. Discussion Inflammatory modulation has been theorized to be beneficial in the management of organ failure secondary to coronavirus infection. A cytokine release syndrome (CRS) has been implicated in this disease’s pathogenesis. Cytokine hemofiltration is one modality to mitigate harmful inflammation. Our patient demonstrated remarkable improvement with treatment and to our knowledge represents the first report of cytokine hemofiltration as management of COVID-19 respiratory failure in conjunction with VV-ECLS. This therapy warrants further evaluation as a treatment option. |
| Databáze: | OpenAIRE |
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