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Additive treatment considerations in COVID-19-The clinician's perspective on extracorporeal adjunctive purification techniques

机译:Covid-19的添加剂治疗考虑 - 临床医生对体外辅助净化技术的看法

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The aim of this document was to inform the scientific community of sparse preliminary results regarding advanced supportive therapies and technology-driven systems in addition to highlighting the benefits and possibilities of performing concise research during challenging times. Advanced organ support for lung and heart offers the possibility to buy the time needed for recovery. However, remaining a bridging strategy, extracorporeal life support cannot act as the ultimate treatment for the underlying COVID-19 disease. Appropriate patient selection criteria addressed by experts and scientific organizations, such as Extracorporeal Life Support Organization and World Health Organization, may provide significant help in the difficult decision-making and to reduce mortality in patients with profound respiratory and/or cardiac failure due to COVID-19. Severe, systemic cytokine-mediated inflammation associated with the SARS-CoV-2 has also been described. Effects of crosstalk between coagulation and inflammatory pathways appear to significantly affect disease progression and lead to poor outcomes. Multiple therapeutic strategies, including antibody therapies (such as Tocilizumab, Sarilumab, Siltuximab), therapeutic plasma exchange (TPE), and blood purification techniques for direct removal of cytokines, including filtration, dialysis (diffusion), and adsorption are available. Further, we believe, that research should be facilitated and promoted, particularly under the guidance of recognized scientific societies or expert-based multicenter investigation, with rapid communication of critical and relevant information to enhance better appraisal of patient profiles, complications, and treatment modalities.
机译:本文件的目的是向科学界通知有关先进的支持疗法和技术驱动系统的稀疏初步结果,以及突出了在挑战时期进行简明研究的益处和可能性。对肺和心灵的高级器官支持提供了购买恢复所需的时间。然而,仍然存在桥接策略,体外寿命支持不能充当潜在的Covid-19疾病的最终治疗。专家和科学组织的适当患者选择标准,如体外生活支持组织和世界卫生组织,可以在困难的决策中提供显着的帮助,并减少由于Covid的呼吸系统和/或心脏病患者的死亡率 - 19。还描述了与SARS-COV-2相关的严重,系统性细胞因子介导的炎症。串扰在凝血和炎症途径之间的影响似乎显着影响疾病进展,导致结果不佳。多种治疗策略,包括抗体疗法(例如对照,Sarilumab,Siltuximab),治疗血浆交换(TPE)和用于直接去除细胞因子的血液净化技术,包括过滤,透析(扩散)和吸附。此外,我们相信,该研究应促进和促进,特别是在认可科学社会或基于专家的多中心调查的指导下,快速沟通关键和相关信息,以提高患者谱,并发症和治疗方式的更好评估。

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