Medical Processes of the Patient with COVID-19 in Intensive Care Unit

Yıl 2020, Cilt: 1 Sayı: 2, 93 - 98, 30.09.2020

İsmail Öztürk Ahmet Göksel Varol Biricik Melis Çakmak Selda Polatdemir Ünase Büyükkoçak

Öz

Coronavirus disease COVID-19 which was first identified in China in December 2019 and leading to severe acute respiratory failure, spread the World rapidly. It was announced as pandemia by the World Health Organisation in March 2020. The male, 74 years old patient treated in General Intensive Care Unit GICU had suspicious contact history. Initially, the patient with no comorbidity was at the ward. On the second day of admission, the patient was accepted to the GICU and applied endotracheal intubation and mechanical ventilation, because of the increase in symtomps of respiratory failure. The patient was extubated on sixteenth day and reintubated after 3 days due to pneumothorax. Immune convalescence plasma and mesenchymal stem cell were applied beside antiviral, antimicrobial therapies. The patient with no response to treatment was died on 26th day. Yet, there is no licensed treatment and vaccine fort this viral pandemia. Although it is observed that some drugs we used in this patient, are effective, in several clinical studies, more studies are necessary for determination of dosage, treatment regimen and adverse effects.

Anahtar Kelimeler

COVID-19, SARS-COV2, antiviral therapy, pneumothorax

COVID-19 Tanısı İle Yoğun Bakımda İzlenen Bir Olgunun Medikal Süreçleri

Öz

Aralık 2019’da ilk olarak Çin’de ortaya çıkan ve ciddi akut solunum yetmezliğine neden olan Koronavirüs hastalığı COVID-19 hızla tüm dünyaya yayılmıştır. Dünya Sağlık Örgütü tarafından Mart ayında pandemi olarak bildirilmiştir. COVID-19 tanısı ile Genel Yoğun Bakım Ünitesi GYBÜ ’nde izlediğimiz 74 yaşındaki erkek hastanın hikayesinde şüpheli temas öyküsü vardı. Ek hastalığı olmayan hasta başlangıçta medikal tedavi ile serviste izlendi. Solunum yetmezliği semptomlarının artması üzerine, yatışının 2. gününde GYBÜ’ne alınarak endotrakeal entübasyon yapıldı ve mekanik ventilasyon uygulandı. On altıncı günde ekstübe edilen hastada 3 gün sonra pnömotoraks gelişmesi üzerine tekrar entübe edildi. Hastaya yoğun bakım süreci içinde antiviral ve antimikrobiyal tedavilerin yanında, immün konvalesan plazma ve mezenkimal kök hücre tedavisi de uygulandı. Tedaviye cevap vermeyen hasta 26.günde eksitus oldu. Henüz bu viral pandemi için onaylanmış bir tedavi ve aşı yoktur. Hastamızın tedavisinde de uyguladığımız bazı ilaçların klinik çalışmalarda etkili olduğu görülmekle birlikte, bu ilaçların dozlama, tedavi akışı ve yan etkilerini belirlemek için daha fazla çalışmaya ihtiyaç vardır.

Anahtar Kelimeler

COVID-19, SARS-COV2, antiviral tedavi, pnömotoraks

Kaynakça

• Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-1207.
• Lu R, Zhao X, Li J, Niu P, Yang B, Wu Het al. Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet 2020;395:565-574.
• T.C. Sağlık Bakanlığı Covid-19 SARS-CoV-2 Enfeksiyonu Genel bilgiler, Epidomiyoloji ve tanı, Bilimsel Danışma Kurulu Çalışması 1 Haziran 2020
• Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C et al. .Transmission of 2019-nCoV infection from an asymptomatic contact in Germany. N Engl J Med 2020;382:970-971.
• Cucinotta D, Vanelli M. WHO Declares COVID-19 a pandemic. Acta Biomed. 2020;91:157-160.
• Wan S, Xiang Y, Fang W, Zheng Y, Li B, Hu Y et al. Clinical features and treatment of COVID-19 patients in northeast Chongqing. J Med Virol 2020;92 7 :797-806. doi:10.1002/jmv.25783.
• Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497- 506.
• Çörtük M, Acat M, Yazici O, Yaşar Z, Kiraz K, Ataman SY et al. Retrospective review of epidemic viral pneumonia cases in Turkey: A multicenter study. Exp Ther Med 2017;13:1431-7.
• Carr AC, Maggini S. Vitamin C and Immune Function. Nutrients 2017;9 11 :1211. doi: 10.3390/nu9111211.
• Wintergerst ES, Maggini S, Hornig DH. Immune-enhancing role of vitamin C and zinc and effect on clinical conditions. Ann Nutr Metab 2006;50 2 :85-94. doi:10.1159/000090495.
• Wang M, Cao R, Zhang L, Yang X, Liu J, Xu M et al. Remdesivir and chloroquine effectively inhibit the recently emerged novel coronavirus 2019- nCoV in vitro. Cell Res 2020;30 3 :269-71. doi: 10.1038/s41422-020-0282-0.
• 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 :72-73. doi: 10.5582/bst.2020.01047.
• Gautret P, Lagier JC, Parola P, Hoang VT, Meddeb L, Mailhe M et al. Hydroxychloroquine and azithromycin as a treatment of COVID-19: results of an open-label non-randomized clinical trial. Int J Antimicrob Agents 2020;56 1 :105949. doi: 10.1016/j.ijantimicag.2020.105949.
• Roques P, Thiberville SD, Dupuis-Maguiraga L, Lum FM, Labadie K, Martinon F et al. Paradoxical effect of chloroquine treatment in enhancing chikungunya virus infection. Viruses 2018;10 5 :268. doi: 10.3390/v10050268.
• Sheppard M, Laskou F, Stapleton PP, Hadavi S, Dasgupta B. Tocilizumab Actemra . Hum Vaccin Immunother 2017;13 9 :1972-1988. doi: 10.1080/21645515.2017.1316909.
• Mehta P, Mc Auley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ et al. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020;395 10229 :1033-1034. doi: 10.1016/S0140-6736 20 30628-0.
• Warren TK, Jordan R, Lo MK, Ray AS, Mackman RL, Soloveva V et al. Therapeutic efficacy of the small molecule GS-5734 againist Ebola virus in rhesus monkeys. Nature. 2016;531 7594 :381-5. doi: 10.1038/nature17180.
• Sheahan TP, Sims AC, Graham RL, Menachery VD, Gralinski LE, Case JB. Broad-spectrum antiviral GS-5734 inhibits both epidemic and zoonotic coronaviruses. .Sci Transl Med 2017;9 396 :eaal3653. doi: 10.1126/ scitranslmed.aal3653.
• Dong L, Hu S, Gao J. Discovering drugs to treat coronavirus disease 2019 COVID-19 . Drug Disc Therap 2020;14:58–60.
• Brown BL, McCulloughb J. Treatment for emerging viruses: Convalescent plasma and COVID-19. Transfus Apher Sci 2020;59 3 :102790. doi: 10.1016/j. transci.2020.102790.
• Bloch EM, Shoham S, Casadevall A, Sachais BS, Shaz B, Winters JL et al. Deployment of Convalescent Plasma for the Prevention and Treatment of COVID-19. J Clin Invest 2020;130 6 :2757-2765. doi: 10.1172/JCI138745.
• Basu-Ray I, Soos MP. Cardiac manifestations of coronavirus COVİD-19 . Stat Pearls. 2020
• Sağlık Bakanlığı Sağlık Hizmetleri Genel Müdürlüğü, Kan ve Kan Ürünleri Dairesi Başkanlığı, Covid-19 İmmün Konvalesan Plazma Tedarik ve Klinik Kullanım Rehberi, Nisan 2020, Ankara
• Tang N, Bai H, Chen X, Gong J, Li D, Sun Z. Anticoagulant treatment is associated with decreased mortality in severe Coronavirus disease 2019 patients with coagulopathy. J Tromb Haemost 2020;1-6.
• Negri EM, Piloto BM, Morinaga LK, Jardim CVP, Lamy SAE-D, Ferreira MA et al. Heparin therapy improving hypoxia in COVID-19 patients - a case series. São Paulo; 2020. doi: 10.1101/2020.04.15.20067017.
• Kochi AN, Tagliari AP, Forleo GB, Fassini GM, Tondo C. Cardiac and arrhythmic complications in patients with COVID-19. J Cardiovasc Electrophysiol 2020;31 5 :1003-1008. doi: 10.1111/jce.14479.
• Burzynski LC, Humphry M, Pyrillou K, Wiggins K, Chan CNE, Figg N et al. The coagulation and immune systems are directly linked through the activation of interleukin-1α by thrombin. Immunity 2019;50 4 : 1033-1042.e6. doi: 10.1016/j.immuni.2019.03.003.
• Song JY, Cheong HJ, Heo JY, Noh JY, Yong HS, Kim YK et al. Clinical, laboratory and radiologic characteristics of 2009 pandemic influenza A/H1N1 pneumonia: primary influenza pneumonia versus concomitant/secondary bacterial pneumonia. Influenza Other Respir Viruses. 2011;5:e535–e543.doi: 10.1111/j.1750-2659.2011.00269.x.
• Ferreira JG, Rapparini C, Gomes BM, Pinto LAC, freire MSSE. Pneumothorax as a late complication of COVID-19. 2020;62:e61. Rev Inst Med Trop Sao Paulo doi: 10.1590/s1678-9946202062061.
• Quincho-Lopez A, Quincho-Lopez DL, Hurtado-Medina FD. Case Report: Pneumothorax and pneumomediastinum as uncommon complications of COVID-19 Pneumonia-Literature Review. Am J Trop Med Hyg 2020;103 3 :1170-1176. doi: 10.4269/ajtmh.20-0815.