Does therapeutic plasma exchange have a role in resistant cytokine storm state of COVID-19 infection?

Introduction: Among the main causes of mortality in COVID-19 patients is cytokine storm (CS) state. Few treatment options with variable efficacy results are available for its management. We aimed to illustrate the efficacy of Therapeutic Plasma Exchange (TPE) treatment in COVID-19 patients with resistant CS.Material and methods: This research is a prospective pilot study which included ten COVID-19 positive patients with CS state with no response after two doses of tocilizumab. Each patient received three to five TPE sessions according to his/her response. Respiratory status {oxygen (O2) requirements and data of mechanical ventilation} and laboratory markers (IL-6, CRP, ferritin, D dimer, LDH) were assessed before and after TPE. We reported mortality at 28 day of illness.Results: Six males and four females were enrolled in the study with a mean age of (52.9 years). Seven patients (70%) were on mechanical ventilation (MV). After TPE, oxygenation parameters and most laboratory markers improved significantly in all patients (p < 0.05). Four patients survived and were discharged (40%). One was on MV and three were not. The four patients had better hypoxic index (PaO2/FiO2 ratio) (˃100 vs <100), started TPE sooner after tocilizumab failure (2–3 vs 5–6 days), needed fewer TPE sessions (3 vs 4–5, p = 0.03), and less duration in ICU (6.5 vs 12.5 days) compared to those who did not benefit.Conclusions: In patients with CS state who did not respond well to tocilizumab and steroids, TPE could be a good option. Larger randomized clinical trials are needed to support its use.Clinical trials registration: ClinicalTrials.gov Identifier:NCT0445734

Impact of implementing a local nutritional strategy on the outcome of critically ill patients in our main hospital

Introduction Introducing proper nutrition interventions to critically ill patients has been proven effective in mitigating the metabolic stress response and positively influencing immune reactions. Providing nutritional support to critically ill patients helps prevent further metabolic decline and preserves lean body mass.Material and Methods This study was conducted in Critical Care Units 1, 2, 3 and 4 at our Main Hospital included 316 patients divided into 2 groups, 155 patient (control group) and 161 patient (interventional group), where the interventional group was subjected to local nutritional protocol; which is based on various existing guidelines, meta-analyses, and randomized controlled trials (RCTs). The comprehensive study focuses on the impact of the local nutritional protocol on length of ICU stay, length of hospital stay, survival at 30 days, and at 90 days.Results There is statistically significant difference between interventional group ICU stay and control group ICU stay with P-value <0.001. Also, there is statistically significant difference between interventional group hospital stay and control group hospital stay with P-value <0.001. For 30 days overall survival; mean survival time of interventional group compared to mean survival time of control group, results show statistically significant with P-value <0.001. For 90 days overall survival; mean survival time of interventional group compared to mean survival time of control group results show statistically significant with P-value <0.001.Conclusions Applying our local nutritional protocol effectively reduced the duration of ICU stay, duration of hospital stay, 30 days all-cause mortality rate and mortality rate at 90 days