چاپ صفحه |  صفحه نخست سامانه |  چکیده مقاله |  نویسندگان |  دانلود مقاله | دانشگاه علوم پزشکی تبریز |
| After COVID-19 outbreak in China in late 2019 and change to pandemic in early 2020, the disease became a clinical threat to the whole world [1]. Urgent clinical guidance for intensive management of critically ill pa-tients is needed. To date, therapeutic options for severe COVID-19 remain limited, and this disease has high mortality in patients admitted to intensive care units (ICUs) [2]. Huang et al. [5] reported the clinical features and cytokine profile of critically ill patients with COV-ID-19 in Wuhan, China, and suggested that a cytokine storm had a high mortality rate and was a leading cause of organ dysfunction and death in these patients. Infec-tious and noninfectious triggers can result in a cytokine storm, progressing to vasoplegic shock and finally multi-organ dysfunction syndrome (MODS) [3]. Early detec-tion and appropriate management of this storm can be an important intervention in decreasing the mortality of critically ill COVID-19 patients. From the first admission of critically ill COVID-19 patients in our ICU on March 10, 2020, we had 8 cases of hemoperfusion in our patients. Our standard treatment protocol beside antiviral therapy for these patients included using HFNC/noninvasive ventilation (Helmet) based on availability as the first choice in patients with acute respiratory failure. If pa-tients failed these interventions and were awake and co-operative, we would try early application of prone posi-tioning (cooperative prone positioning) with noninvasive ventilation/HFNC as long as they tolerate. If the situation went wrong, we would try intubation and mechanical ventilation with lung protective strategy (tidal volume of 4–6 mL/predicted body weight and adjustment of it based on driving pressure of 14 cm H2O and plateau pressure of 30 cm H2O). PEEP was adjusted and titrated based on stress index and driving pressure. However, if increasing PEEP resulted in improved oxygenation, we would in-crease the PEEP number, but if increasing PEEP did not result in improving oxygenation, we would consider the patient as a nonresponder and would not increase PEEP to more than 12 cm H2O. We used adjunctive therapies in patients with cytokine storm without considering the method of ventilation. If the patient had at least 2 of the criteria in Figure 1, the situation would be considered as cytokine storm. Cytokine storm was diagnosed in 8 pa-tients; 4 of them were nonintubated. One patient received 4 sessions of hemoperfusion, and 1 patient received just 2 sessions as he died before the third session |
| نویسنده | نفر چندم مقاله |
|---|---|
| کامران شادور | اول |
| علی تقی زادیه | دوم |
| علی اکبر قمری | سوم |
| حسن سلیمانپور | چهارم |
| عطا محمودپور | پنجم |
| نام فایل | تاریخ درج فایل | اندازه فایل | دانلود |
|---|---|---|---|
| hemoperfusion.pdf | 1399/08/25 | 159403 | دانلود |
| 91140273.pdf | 1400/08/22 | 483451 | دانلود |
| 91143186.pdf | 1400/08/23 | 509588 | دانلود |
