Management of patients with severe acute respiratory failure due to SARS-CoV-2 pneumonia with noninvasive ventilatory support outside Intensive Care Unit

Terán, Teresa Díaz de; Martinez, Monica Gonzales; Banfi, Paolo; Garuti, Giancarlo; Ferraioli, Gianluca; Russo, Giuseppe; Casu, Francesco; Vivarelli, Michela; Bonfiglio, Monica; Perazzo, Alessandro; Barlascini, Cornelius; Bauleo, Armando; Nicolini, Antonello; Solidoro, Paolo

doi:10.23736/s0026-4806.21.07134-2

Cited by 14 publications

(1 citation statement)

References 32 publications

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“…The SARS-CoV-2 coronavirus mainly affects the respiratory system of the patient via the angiotensin-converting enzyme 2 (ACE-2) receptors. In the respiratory system, by binding to the cells that build the alveoli of the lungs, it causes various symptoms, from completely non-threatening to respiratory failure requiring intensive care [ 6 , 7 ]. In the cardiovascular system, SARS-CoV-2 infection leads to complications such as infarction and inflammation of the heart muscle, exacerbation of heart failure, and arrhythmias [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

What Is Currently Known about the Role of CXCL10 in SARS-CoV-2 Infection?

Gudowska-Sawczuk

Mroczko

2022

IJMS

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Dysregulation of the immune response plays an important role in the progression of SARS-CoV-2 infection. A “cytokine storm”, which is a phenomenon associated with uncontrolled production of large amounts of cytokines, very often affects patients with COVID-19. Elevated activity of chemotactic cytokines, called chemokines, can lead to serious consequences. CXCL10 has an ability to activate its receptor CXCR3, predominantly expressed on macrophages, T lymphocytes, dendritic cells, natural killer cells, and B cells. So, it has been suggested that the chemokine CXCL10, through CXCR3, is associated with inflammatory diseases and may be involved in the development of COVID-19. Therefore, in this review paper, we focus on the role of CXCL10 overactivity in the pathogenesis of COVID-19. We performed an extensive literature search for our investigation using the MEDLINE/PubMed database. Increased concentrations of CXCL10 were observed in COVID-19. Elevated levels of CXCL10 were reported to be associated with a severe course and disease progression. Published studies revealed that CXCL10 may be a very good predictive biomarker of patient outcome in COVID-19, and that markedly elevated CXCL10 levels are connected with ARDS and neurological complications. It has been observed that an effective treatment for SARS-CoV-2 leads to inhibition of “cytokine storm”, as well as reduction of CXCL10 concentrations. It seems that modulation of the CXCL10–CXCR3 axis may be an effective therapeutic target of COVID-19. This review describes the potential role of CXCL10 in the pathogenesis of COVID-19, as well as its potential immune–therapeutic significance. However, future studies should aim to confirm the prognostic, clinical, and therapeutic role of CXCL10 in SARS-CoV-2 infection.

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Section: Introductionmentioning

confidence: 99%

What Is Currently Known about the Role of CXCL10 in SARS-CoV-2 Infection?

Gudowska-Sawczuk

Mroczko

2022

IJMS

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Severe covid-19 pneumonia: pathogenesis and clinical management

Attaway

Scheraga

Bhimraj

et al. 2021

BMJ

325

248

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Severe covid-19 pneumonia has posed critical challenges for the research and medical communities. Older age, male sex, and comorbidities increase the risk for severe disease. For people hospitalized with covid-19, 15-30% will go on to develop covid-19 associated acute respiratory distress syndrome (CARDS). Autopsy studies of patients who died of severe SARS CoV-2 infection reveal presence of diffuse alveolar damage consistent with ARDS but with a higher thrombus burden in pulmonary capillaries. When used appropriately, high flow nasal cannula (HFNC) may allow CARDS patients to avoid intubation, and does not increase risk for disease transmission. During invasive mechanical ventilation, low tidal volume ventilation and positive end expiratory pressure (PEEP) titration to optimize oxygenation are recommended. Dexamethasone treatment improves mortality for the treatment of severe and critical covid-19, while remdesivir may have modest benefit in time to recovery in patients with severe disease but shows no statistically significant benefit in mortality or other clinical outcomes. Covid-19 survivors, especially patients with ARDS, are at high risk for long term physical and mental impairments, and an interdisciplinary approach is essential for critical illness recovery.

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