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Annals of Intensive Care
Published in: Annals of Intensive Care 1/2020

Open Access 01-12-2020 | Coronavirus | Review

Therapeutic strategies for critically ill patients with COVID-19

Authors: Lei Li, Ranran Li, Zhixiong Wu, Xianghong Yang, Mingyan Zhao, Jiao Liu, Dechang Chen

Published in: Annals of Intensive Care | Issue 1/2020

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Abstract

Since the 2019 novel coronavirus disease (COVID-19) outbreak originated from Wuhan, Hubei Province, China, at the end of 2019, it has become a clinical threat to the general population worldwide. Among people infected with the novel coronavirus (2019-nCoV), the intensive management of the critically ill patients in intensive care unit (ICU) needs substantial medical resource. In the present article, we have summarized the promising drugs, adjunctive agents, respiratory supportive strategies, as well as circulation management, multiple organ function monitoring and appropriate nutritional strategies for the treatment of COVID-19 in the ICU based on the previous experience of treating other viral infections and influenza. These treatments are referable before the vaccine and specific drugs are available for COVID-19.
Literature
1.
2.
Organization WH. clinical-management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected-interim guidance. Published January 28, 2020.
3.
4.
Hui DS, Azhar I, Madani TA, et al. The continuing 2019-nCoV epidemic threat of novel coronaviruses to global health—the latest, novel coronavirus outbreak in Wuhan, China. Int J Infect Dis. 2019;2020(91):264–6.
5.
Lu R, Zhao X, Li J, et al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020;395(10224):565–74.PubMedPubMedCentralCrossRef
6.
Yu YX, Sun L, Yao K, et al. Consideration and prevention for the aerosol transmission of 2019 novel coronavirus. Zhonghua Yan Ke Za Zhi. 2020;56:E008.
7.
8.
9.
10.
Booth CM, Matukas LM, Tomlinson GA, et al. Clinical features and short-term outcomes of 144 patients with SARS in the greater Toronto area. JAMA. 2003;289(21):2801–9.PubMedCrossRef
11.
Lee N, Hui D, Wu A, et al. A major outbreak of severe acute respiratory syndrome in Hong Kong. N Engl J Med. 2003;348(20):1986–94.PubMedCrossRef
12.
13.
14.
15.
Kim UJ, Won EJ, Kee SJ, et al. Combination therapy with lopinavir/ritonavir, ribavirin and interferon-alpha for Middle East respiratory syndrome. Antivir Ther. 2016;21(5):455–9.PubMedCrossRef
16.
Omrani AS, Saad MM, Baig K, et al. Ribavirin and interferon alfa-2a for severe Middle East respiratory syndrome coronavirus infection: a retrospective cohort study. Lancet Infect Dis. 2014;14(11):1090–5.PubMedPubMedCentralCrossRef
17.
Chu CM, Cheng VC, Hung IF, et al. Role of lopinavir/ritonavir in the treatment of SARS: initial virological and clinical findings. Thorax. 2004;59(3):252–6.PubMedPubMedCentralCrossRef
18.
19.
Mulangu S, Dodd LE, Davey RT Jr, et al. A randomized, controlled trial of ebola virus disease therapeutics. N Engl J Med. 2019;381(24):2293–303.PubMedCrossRef
20.
21.
22.
Sheahan TP, Sims AC, Leist SR, et al. Comparative therapeutic efficacy of remdesivir and combination lopinavir, ritonavir, and interferon beta against MERS-CoV. Nat Communs. 2020;11(1):222.CrossRef
23.
24.
25.
26.
27.
Boriskin YS, Leneva IA, Pecheur EI, et al. Arbidol: a broad-spectrum antiviral compound that blocks viral fusion. Curr Med Chem. 2008;15(10):997–1005.PubMedCrossRef
28.
Khamitov RA, Loginova S, Shchukina VN, et al. Antiviral activity of arbidol and its derivatives against the pathogen of severe acute respiratory syndrome in the cell cultures. Vopr Virusol. 2008;53(4):9–13.PubMed
29.
30.
31.
32.
33.
Simmons G, Reeves JD, Rennekamp AJ, et al. Characterization of severe acute respiratory syndrome-associated coronavirus (SARS-CoV) spike glycoprotein-mediated viral entry. Proc Natl Acad Sci USA. 2004;101(12):4240–5.PubMedCrossRefPubMedCentral
34.
Yeung KS, Yamanaka GA, Meanwell NA. Severe acute respiratory syndrome coronavirus entry into host cells: opportunities for therapeutic intervention. Med Res Rev. 2006;26(4):414–33.PubMedCrossRefPubMedCentral
35.
Yan Y, Zou Z, Sun Y, et al. Anti-malaria drug chloroquine is highly effective in treating avian influenza A H5N1 virus infection in an animal model. Cell Res. 2013;23(2):300–2.PubMedCrossRef
36.
37.
38.
39.
Gao J, Tian Z, Yang X. Breakthrough: chloroquine phosphate has shown apparent efficacy in treatment of COVID-19 associated pneumonia in clinical studies. Biosci Trends. 2020;14(1):72–3.PubMedCrossRef
40.
41.
Ponticelli C, Moroni G. Hydroxychloroquine in systemic lupus erythematosus (SLE). Expert Opin Drug Saf. 2017;16(3):411–9.PubMedCrossRef
42.
Schrezenmeier E, Dorner T. Mechanisms of action of hydroxychloroquine and chloroquine: implications for rheumatology. Nat Rev Rheumatol. 2020;16(3):155–66.PubMedCrossRef
43.
44.
45.
Uyeki TM, Bernstein HH, Bradley JS, et al. clinical practice guidelines by the infectious diseases society of America: 2018 update on diagnosis, treatment, chemoprophylaxis, and institutional outbreak management of seasonal influenza. Clin Infect Dis. 2019;68(6):895–902.PubMedPubMedCentralCrossRef
46.
47.
Beigel JH, Nam HH, Adams PL, et al. Advances in respiratory virus therapeutics—A meeting report from the 6th isirv Antiviral Group conference. Antiviral Res. 2019;167:45–67.PubMedPubMedCentralCrossRef
48.
Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507–13.PubMedPubMedCentralCrossRef
49.
Zhao Z, Zhang F, Xu M, et al. Description and clinical treatment of an early outbreak of severe acute respiratory syndrome (SARS) in Guangzhou, P. R. China. J Med Microbiol. 2003;52(Pt 8):715–20.PubMedCrossRef
50.
Ho JC, Ooi GC, Mok TY, et al. High-dose pulse versus nonpulse corticosteroid regimens in severe acute respiratory syndrome. Am J Respir Crit Care Med. 2003;168(12):1449–56.PubMedCrossRef
51.
52.
Ni YN, Chen G, Sun J, et al. The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care. 2019;23(1):99.PubMedPubMedCentralCrossRef
53.
Yang JW, Fan LC, Miao XY, et al. Corticosteroids for the treatment of human infection with influenza virus: a systematic review and meta-analysis. Clin Microbiol Infect. 2015;21(10):956–63.PubMedCrossRef
54.
Martin-Loeches I, Lisboa T, Rhodes A, et al. Use of early corticosteroid therapy on ICU admission in patients affected by severe pandemic (H1N1)v influenza A infection. Intensive Care Med. 2011;37(2):272–83.PubMedCrossRef
55.
Giannella M, Alonso M, Garcia de Viedma D, et al. Prolonged viral shedding in pandemic influenza A(H1N1): clinical significance and viral load analysis in hospitalized patients. Clin Microbiol Infect. 2011;17(8):1160–5.PubMedCrossRef
56.
Wang Y, Guo Q, Yan Z, et al. Factors associated with prolonged viral shedding in patients with avian influenza A(H7N9) virus infection. J Infect Dis. 2018;217(11):1708–17.PubMedCrossRef
57.
Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid therapy for critically Ill patients with Middle East respiratory syndrome. Am J Respir Crit Care Med. 2018;197(6):757–67.PubMedCrossRef
58.
Han K, Ma H, An X, et al. Early use of glucocorticoids was a risk factor for critical disease and death from pH1N1 infection. Clin Infect Dis. 2011;53(4):326–33.PubMedCrossRef
59.
Matteucci C, Grelli S, Balestrieri E, et al. Thymosin alpha 1 and HIV-1: recent advances and future perspectives. Fut Microbiol. 2017;12:141–55.CrossRef
60.
Pica F, Gaziano R, Casalinuovo IA, et al. Serum thymosin alpha 1 levels in normal and pathological conditions. Expert Opin Biol Ther. 2018;18(sup1):13–21.PubMedCrossRef
61.
Wu J, Zhou L, Liu J, et al. The efficacy of thymosin alpha 1 for severe sepsis (ETASS): a multicenter, single-blind, randomized and controlled trial. Crit Care. 2013;17(1):R8.PubMedPubMedCentralCrossRef
62.
Gao ZC, Zhu JH, Sun Y, et al. Clinical investigation of outbreak of nosocomial severe acute respiratory syndrome. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue. 2003;15(6):332–5.PubMed
63.
Dawar FU, Tu J, Khattak MN, et al. Cyclophilin A: a key factor in virus replication and potential target for anti-viral therapy. Curr Issues Mol Biol. 2017;21:1–20.PubMed
64.
Pfefferle S, Schopf J, Kogl M, et al. The SARS-coronavirus-host interactome: identification of cyclophilins as target for pan-coronavirus inhibitors. PLoS Pathog. 2011;7(10):e1002331.PubMedPubMedCentralCrossRef
65.
Morgenstern B, Michaelis M, Baer PC, et al. Ribavirin and interferon-beta synergistically inhibit SARS-associated coronavirus replication in animal and human cell lines. Biochem Biophys Res Commun. 2005;326(4):905–8.PubMedCrossRef
66.
Mustafa S, Balkhy H, Gabere MN. Current treatment options and the role of peptides as potential therapeutic components for Middle East Respiratory Syndrome (MERS): a review. J Infect Public Health. 2018;11(1):9–17.PubMedCrossRef
67.
Kuri T, Zhang X, Habjan M, et al. Interferon priming enables cells to partially overturn the SARS coronavirus-induced block in innate immune activation. J Gen Virol. 2009;90(Pt 11):2686–94.PubMedPubMedCentralCrossRef
68.
Werdan K, Pilz G, Bujdoso O, et al. Score-based immunoglobulin G therapy of patients with sepsis: the SBITS study. Crit Care Med. 2007;35(12):2693–701.PubMedCrossRef
69.
70.
Chen C, Zhang XR, Ju ZY, et al. Advances in the research of cytokine storm mechanism induced by Corona Virus Disease 2019 and the corresponding immunotherapies. Zhonghua Shao Shang Za Zhi. 2020;36:E005.
71.
Hoffman E, Rahat MA, Feld J, et al. Effects of Tocilizumab, an anti-interleukin-6 receptor antibody, on serum lipid and Adipokine levels in patients with rheumatoid arthritis. Int J Mol Sci. 2019;20:18.
72.
Le RQ, Li L, Yuan W, et al. FDA approval summary: tocilizumab for treatment of chimeric antigen receptor T cell-induced severe or life-threatening cytokine release syndrome. Oncologist. 2018;23(8):943–7.PubMedPubMedCentralCrossRef
73.
74.
Liu J, Manheimer E, Shi Y, et al. Chinese herbal medicine for severe acute respiratory syndrome: a systematic review and meta-analysis. J Altern Complem Med. 2004;10(6):1041–51.CrossRef
75.
Ji S, Bai Q, Wu X, et al. Unique synergistic antiviral effects of Shufeng Jiedu Capsule and oseltamivir in influenza A viral-induced acute exacerbation of chronic obstructive pulmonary disease. Biomed Pharmacother. 2020;121:109652.PubMedCrossRef
76.
Ding Y, Zeng L, Li R, et al. The Chinese prescription lianhuaqingwen capsule exerts anti-influenza activity through the inhibition of viral propagation and impacts immune function. BMC Complement Altern Med. 2017;17(1):130.PubMedPubMedCentralCrossRef
77.
Du CY, Zheng KY, Bi CW, et al. Yu Ping Feng San, an ancient Chinese herbal decoction, induces gene expression of anti-viral proteins and inhibits neuraminidase activity. Phytother Res. 2015;29(5):656–61.PubMedCrossRef
78.
Wang C, Cao B, Liu QQ, et al. Oseltamivir compared with the Chinese traditional therapy maxingshigan-yinqiaosan in the treatment of H1N1 influenza: a randomized trial. Ann Intern Med. 2011;155(4):217–25.PubMedCrossRef
79.
Marano G, Vaglio S, Pupella S, et al. Convalescent plasma: new evidence for an old therapeutic tool? Blood Trans. 2016;14(2):1–6.
80.
Burnouf T, Conton B, Dye JM. Convalescent plasma for Ebola virus disease. N Engl J Med. 2016;374(25):2498–500.CrossRef
81.
Soo YO, Cheng Y, Wong R, et al. Retrospective comparison of convalescent plasma with continuing high-dose methylprednisolone treatment in SARS patients. Clin Microbiol Infect. 2004;10(7):676–8.PubMedPubMedCentralCrossRef
82.
Cheng Y, Wong R, Soo YO, et al. Use of convalescent plasma therapy in SARS patients in Hong Kong. Eur J Clin Microbiol Infect Dis. 2005;24(1):44–6.PubMedCrossRef
83.
Lu CL, Murakowski DK, Bournazos S, et al. Enhanced clearance of HIV-1-infected cells by broadly neutralizing antibodies against HIV-1 in vivo. Science. 2016;352(6288):1001–4.PubMedPubMedCentralCrossRef
84.
Zhao J, Perera RA, Kayali G, et al. Passive immunotherapy with dromedary immune serum in an experimental animal model for Middle East respiratory syndrome coronavirus infection. J Virol. 2015;89(11):6117–20.PubMedPubMedCentralCrossRef
85.
86.
Fowler RA, Lapinsky SE, Hallett D, et al. Critically ill patients with severe acute respiratory syndrome. JAMA. 2003;290(3):367–73.PubMedCrossRef
87.
Kumar A, Zarychanski R, Pinto R, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009;302(17):1872–9.PubMedCrossRef
88.
Rochwerg B, Brochard L, Elliott MW, et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017;50:2.CrossRef
89.
Frat JP, Thille AW, Mercat A, et al. High-flow oxygen through nasal cannula in acute hypoxemic respiratory failure. N Engl J Med. 2015;372(23):2185–96.PubMedCrossRef
90.
Hui DS, Chow BK, Lo T, et al. Exhaled air dispersion during high-flow nasal cannula therapy versus CPAP via different masks. Eur Respir J. 2019;53:4.CrossRef
91.
92.
Society RccoCT. Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia. Zhonghua Jie He He Hu Xi Za Zhi. 2020;17:E020.
93.
94.
Guérin C, Reignier J, Richard J-C, et al. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013;368(23):2159–68.PubMedCrossRef
95.
Xu Y, Deng X, Han Y, et al. A multicenter retrospective review of prone position ventilation (PPV) in treatment of severe human H7N9 Avian flu. PLoS ONE. 2015;10(8):e0136520.PubMedPubMedCentralCrossRef
96.
Noah MA, Peek GJ, Finney SJ, et al. Referral to an extracorporeal membrane oxygenation center and mortality among patients with severe 2009 influenza A(H1N1). JAMA. 2011;306(15):1659–68.PubMedCrossRef
97.
Alshahrani MS, Sindi A, Alshamsi F, et al. Extracorporeal membrane oxygenation for severe Middle East respiratory syndrome coronavirus. Ann Intensive Care. 2018;8(1):3.PubMedPubMedCentralCrossRef
98.
99.
Metadata
Title
Therapeutic strategies for critically ill patients with COVID-19
Authors
Lei Li
Ranran Li
Zhixiong Wu
Xianghong Yang
Mingyan Zhao
Jiao Liu
Dechang Chen
Publication date
01-12-2020
Publisher
Springer International Publishing
Published in
Annals of Intensive Care / Issue 1/2020
Electronic ISSN: 2110-5820
DOI
https://doi.org/10.1186/s13613-020-00661-z

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