Fahad Faqihi1, Abdulrahman Alharthy2, Mohammed Alodat2, Demetrios J Kutsogiannis3, Peter G Brindley4, Dimitrios Karakitsos5. 1. Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Critical Care Department, Al Imam Abdulrahman Al Feisal Hospital, Riyadh, Saudi Arabia. 2. Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia. 3. Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada. Electronic address: djk3@ualberta.ca. 4. Department of Critical Care, Faculty of Medicine and Dentistry, the University of Alberta, Alberta, Canada. Electronic address: Peter.Brindley@albertahealthservices.ca. 5. Critical Care Department, King Saud Medical City, Riyadh, Saudi Arabia; Department of Internal Medicine, South Carolina University, School of Medicine, Columbia, SC, USA; Critical Care Department, Keck Medical School, USC, LA, CA, USA. Electronic address: karakitsosdimitrios@gmail.com.
Abstract
PURPOSE: We investigated the effect of therapeutic plasma exchange (TPE) on life-threatening COVID-19; presenting as acute respiratory distress syndrome (ARDS) plus multi-system organ failure and cytokine release syndrome (CRS). MATERIALS AND METHODS: We prospectively enrolled ten consecutive adult intensive care unit (ICU) subjects [7 males; median age: 51 interquartile range (IQR): 45.1-55.9 years old] with life-threatening COVID-19 infection. All had ARDS [PaO2/FiO2 ratio: 110 (IQR): 95.5-135.5], septic shock, CRS and deteriorated within 24 h of ICU admission despite fluid resuscitation, antibiotics, hydroxychloroquine, ARDS-net and prone position mechanical ventilation. All received 5-7 TPE sessions (dosed as 1.0 to 1.5 plasma volumes). RESULTS: All of the following significantly normalized (p < 0.05) following the TPE completion, when compared to baseline: Sequential Organ Function Assessment score, PaO2/FiO2 ratio, levels of lymphocytes, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6. No adverse effects from TPE were observed. Acute kidney injury and pulmonary embolism were observed in 10% and 20% of patients, respectively. The duration of mechanical ventilation was 9 (IQR: 7 to 12) days, the ICU length of stay was 15 (IQR: 13.2 to 19.6) days and the mortality on day-28 was 10%. CONCLUSION: TPE demonstrates a potential survival benefit and low risk in life-threatening COVID-19, albeit in a small pilot study.
PURPOSE: We investigated the effect of therapeutic plasma exchange (TPE) on life-threatening COVID-19; presenting as acute respiratory distress syndrome (ARDS) plus multi-system organ failure and cytokine release syndrome (CRS). MATERIALS AND METHODS: We prospectively enrolled ten consecutive adult intensive care unit (ICU) subjects [7 males; median age: 51 interquartile range (IQR): 45.1-55.9 years old] with life-threatening COVID-19infection. All had ARDS [PaO2/FiO2 ratio: 110 (IQR): 95.5-135.5], septic shock, CRS and deteriorated within 24 h of ICU admission despite fluid resuscitation, antibiotics, hydroxychloroquine, ARDS-net and prone position mechanical ventilation. All received 5-7 TPE sessions (dosed as 1.0 to 1.5 plasma volumes). RESULTS: All of the following significantly normalized (p < 0.05) following the TPE completion, when compared to baseline: Sequential Organ Function Assessment score, PaO2/FiO2 ratio, levels of lymphocytes, total bilirubin, lactate dehydrogenase, ferritin, C-reactive protein and interleukin-6. No adverse effects from TPE were observed. Acute kidney injury and pulmonary embolism were observed in 10% and 20% of patients, respectively. The duration of mechanical ventilation was 9 (IQR: 7 to 12) days, the ICU length of stay was 15 (IQR: 13.2 to 19.6) days and the mortality on day-28 was 10%. CONCLUSION: TPE demonstrates a potential survival benefit and low risk in life-threatening COVID-19, albeit in a small pilot study.
Authors: Gopal K Patidar; Kevin J Land; Hans Vrielink; Naomi Rahimi-Levene; Eldad J Dann; Hind Al-Humaidan; Steven L Spitalnik; Yashaswi Dhiman; Cynthia So-Osman; Salwa I Hindawi Journal: Vox Sang Date: 2021-03-17 Impact factor: 2.996
Authors: Paola de Candia; Francesco Prattichizzo; Silvia Garavelli; Rosalba La Grotta; Annunziata De Rosa; Agostina Pontarelli; Roberto Parrella; Antonio Ceriello; Giuseppe Matarese Journal: iScience Date: 2021-07-22
Authors: A Alharthy; A Balhamar; F Faqihi; N Nasim; A F Noor; S A Alqahtani; Z A Memish; D Karakitsos Journal: New Microbes New Infect Date: 2020-11-17
Authors: Abdulrahman Alharthy; Fahad Faqihi; Nasir Nasim; Alfateh Noor; Saima Akhtar; Ahmed Balshi; Abdullah Balhamar; Saleh A Alqahtani; Ziad A Memish; Dimitrios Karakitsos Journal: Respir Med Case Rep Date: 2020-10-15