Successful Treatment of a Critically Ill COVID-19 Patient Using Continuous Renal Replacement Therapy With Enhanced Cytokine Removal and Tocilizumab: A Case Report

Frontiers in Medicine

article

Thomas Tao-Min Huang¹  Bor-Luen Chiang²  Shan-Chwen Chang¹  Ashita Tolwani³  Ying-Chun Chien¹  Chih-Hsien Wang⁴  Sui-Yuan Chang⁵  Jann-Tay Wang¹  Song-Chou Hsieh¹  Yu-Chang Yeh⁶  Shih-Chi Ku¹  Chong-Jen Yu¹ 

[1] Department of Internal Medicine, National Taiwan University Hospital and College of Medicine;Department of Pediatrics, National Taiwan University Hospital and College of Medicine, National Taiwan University;Division of Nephrology, University of Alabama, United States;Department of Surgery, National Taiwan University Hospital and College of Medicine;Department of Clinical Laboratory Sciences and Medical Biotechnology, National Taiwan University College of Medicine;Department of Anesthesiology, National Taiwan University Hospital and College of Medicine

关键词: COVID-19;    cytokine release syndrome;    extracorporeal membrane oxygenation;    continuous renal replacement therapy;    tocilizumab;   

DOI  :  10.3389/fmed.2021.649583

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

The COVID-19 pandemic has caused multiple deaths worldwide. Since no specific therapies are currently available, treatment for critically ill patients with COVID-19 is supportive. The most severe patients need sustained life support for recovery. We herein describe the course of a critically ill COVID-19 patient with multi-organ failure, including acute respiratory failure, acute kidney injury, and fulminant cytokine release syndrome (CRS), who required mechanical ventilation and extracorporeal membrane oxygenation support. This patient with a predicted high mortality risk was successfully managed with a careful strategy of oxygenation, uremic toxin removal, hemodynamic support, and most importantly, cytokine-targeted intervention for CRS, including cytokine/endotoxin removal, anti-cytokine therapy, and immune modulation. Comprehensive cytokine data, CRS parameters, and biochemical data of extracorporeal removal were provided to strengthen the rationale of this strategy. In this report, we demonstrate that timely combined hemoperfusion with cytokine adsorptive capacity and anti-cytokine therapy can successfully treat COVID-19 patients with fulminant CRS. It also highlights the importance of implementing cytokine-targeted therapy for severe COVID-19 guided by the precise measurement of disease activity.

【 授权许可】

CC BY