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World Journal of Clinical Cases May 2021Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus...
BACKGROUND
Several reports with clinical, histological and imaging data have observed the involvement of lung vascular function to explain the severe hypoxemia in coronavirus disease 2019 (COVID-19) patients. It has been hypothesized that an increased pulmonary blood flow associated with an impairment of hypoxic pulmonary vasoconstriction is responsible for an intrapulmonary shunt. COVID-19 may lead to refractory hypoxemia (PaO/FiO ratio below 100 mmHg) despite mechanical ventilation and prone positioning. We hypothesized that the use of a pulmonary vasoconstrictor may help decrease the shunt and thus enhance oxygenation.
CASE SUMMARY
We report our experience with three patients with refractory hypoxemia treated with almitrine to enhance oxygenation. Low dose almitrine (Vectarion; Servier, Suresnes, France) was started at an infusion rate of 4 μg × kg/min on a central line. The PaO/FiO ratio and total respiratory system compliance during almitrine infusion were measured. For the three patients, the PaO/FiO ratio time-course showed a dramatic increase whereas total respiratory system compliance was unchanged. The three patients were discharged from the intensive care unit. The intensive care unit length of stay for patient 1, patient 2 and patient 3 was 30 d, 32 d and 31 d, respectively. Weaning from mechanical ventilation was performed 13 d, 18 d and 15 d after almitrine infusion for patient 1, 2 and 3, respectively. We found no deleterious effects on the right ventricular function, which was similar to previous studies on almitrine safety.
CONCLUSION
Almitrine may be effective and safe to enhance oxygenation in coronavirus disease 2019 patients. Further controlled studies are required.
PubMed: 34002149
DOI: 10.12998/wjcc.v9.i14.3385 -
Saudi Journal of Anaesthesia 2021
PubMed: 33824652
DOI: 10.4103/sja.SJA_782_20 -
Biochemical Pharmacology Jan 2021The outbreak of a novel coronavirus (SARS-CoV-2) has caused a major public health concern across the globe. SARS-CoV-2 is the seventh coronavirus that is known to cause... (Review)
Review
The outbreak of a novel coronavirus (SARS-CoV-2) has caused a major public health concern across the globe. SARS-CoV-2 is the seventh coronavirus that is known to cause human disease. As of September 2020, SARS-CoV-2 has been reported in 213 countries and more than 31 million cases have been confirmed, with an estimated mortality rate of ∼3%. Unfortunately, a drug or vaccine is yet to be discovered to treat COVID-19. Thus, repurposing of existing cancer drugs will be a novel approach in treating COVID-19 patients. These drugs target viral replication cycle, viral entry and translocation to the nucleus. Some can enhance innate antiviral immune response as well. Hence this review focuses on comprehensive list of 22 drugs that work against COVID-19 infection. These drugs include fingolimod, colchicine, N4-hydroxycytidine, remdesivir, methylprednisone, oseltamivir, icatibant, perphanizine, viracept, emetine, homoharringtonine, aloxistatin, ribavirin, valrubicin, famotidine, almitrine, amprenavir, hesperidin, biorobin, cromolyn sodium, and antibodies- tocilzumab and sarilumab. Also, we provide a list of 31 drugs that are predicted to function against SARS-CoV-2 infection. In summary, we provide succinct overview of various therapeutic modalities. Among these 53 drugs, based on various clinical trials and literature, remdesivir, nelfinavir, methylpredinosolone, colchicine, famotidine and emetine may be used for COVID-19. SIGNIFICANCE: It is of utmost important priority to develop novel therapies for COVID-19. Since the effect of SARS-CoV-2 is so severe, slowing the spread of diseases will help the health care system, especially the number of visits to Intensive Care Unit (ICU) of any country. Several clinical trials are in works around the globe. Moreover, NCI developed a recent and robust response to COVID-19 pandemic. One of the NCI's goals is to screen cancer related drugs for identification of new therapies for COVID-19. https://www.cancer.gov/news-events/cancer-currents-blog/2020/covid-19-cancer-nci-response?cid=eb_govdel.
Topics: Adenosine Monophosphate; Alanine; Anti-Inflammatory Agents; Antioxidants; Antiviral Agents; Drug Repositioning; Humans; SARS-CoV-2; Treatment Outcome; Virus Internalization; COVID-19 Drug Treatment
PubMed: 33191206
DOI: 10.1016/j.bcp.2020.114296 -
Annals of Intensive Care Nov 2020In COVID-19 patients with severe acute respiratory distress syndrome (ARDS), the relatively preserved respiratory system compliance despite severe hypoxemia, with...
BACKGROUND
In COVID-19 patients with severe acute respiratory distress syndrome (ARDS), the relatively preserved respiratory system compliance despite severe hypoxemia, with specific pulmonary vascular dysfunction, suggests a possible hemodynamic mechanism for VA/Q mismatch, as hypoxic vasoconstriction alteration. This study aimed to evaluate the capacity of inhaled nitric oxide (iNO)-almitrine combination to restore oxygenation in severe COVID-19 ARDS (C-ARDS) patients.
METHODS
We conducted a monocentric preliminary pilot study in intubated patients with severe C-ARDS. Respiratory mechanics was assessed after a prone session. Then, patients received iNO (10 ppm) alone and in association with almitrine (10 μg/kg/min) during 30 min in each step. Echocardiographic and blood gases measurements were performed at baseline, during iNO alone, and iNO-almitrine combination. The primary endpoint was the variation of oxygenation (PaO/FiO ratio).
RESULTS
Ten severe C-ARDS patients were assessed (7 males and 3 females), with a median age of 60 [52-72] years. Combination of iNO and almitrine outperformed iNO alone for oxygenation improvement. The median of PaO/FiO ratio varied from 102 [89-134] mmHg at baseline, to 124 [108-146] mmHg after iNO (p = 0.13) and 180 [132-206] mmHg after iNO and almitrine (p < 0.01). We found no correlation between the increase in oxygenation caused by iNO-almitrine combination and that caused by proning.
CONCLUSION
In this pilot study of severe C-ARDS patients, iNO-almitrine combination was associated with rapid and significant improvement of oxygenation. These findings highlight the role of pulmonary vascular function in COVID-19 pathophysiology.
PubMed: 33150525
DOI: 10.1186/s13613-020-00769-2 -
JACC. Case Reports Jul 2020Coronavirus disease-19 (COVID-19)-related severe acute respiratory distress syndrome can lead to acute cor pulmonale. We report a case of acute cor pulmonale secondary...
Coronavirus disease-19 (COVID-19)-related severe acute respiratory distress syndrome can lead to acute cor pulmonale. We report a case of acute cor pulmonale secondary to severe COVID-19 acute respiratory distress syndrome diagnosed with transesophageal echocardiography. Almitrine infusion allowed rapid enhancement of right ventricular function as well as improvement in oxygenation. ().
PubMed: 32835274
DOI: 10.1016/j.jaccas.2020.06.011 -
Anaesthesia, Critical Care & Pain... Aug 2020
Topics: Almitrine; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Hypoxia; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; Respiratory System Agents; SARS-CoV-2
PubMed: 32653550
DOI: 10.1016/j.accpm.2020.07.003 -
Chest Nov 2020
Topics: Aged; Almitrine; Betacoronavirus; Blood Gas Analysis; COVID-19; Coronavirus Infections; Extracorporeal Membrane Oxygenation; Female; Humans; Hypoxia; Male; Middle Aged; Oxygen; Oxygen Inhalation Therapy; Pandemics; Partial Pressure; Patient Positioning; Pneumonia, Viral; Positive-Pressure Respiration; Prone Position; Respiration, Artificial; Respiratory Distress Syndrome; Respiratory System Agents; Retrospective Studies; SARS-CoV-2; Treatment Outcome
PubMed: 32512007
DOI: 10.1016/j.chest.2020.05.573 -
Anaesthesia, Critical Care & Pain... Aug 2020
Topics: Aged; Almitrine; Betacoronavirus; COVID-19; Case-Control Studies; Coronavirus Infections; Female; Humans; Hypoxia; Injections, Intravenous; Male; Middle Aged; Oxygen; Pandemics; Partial Pressure; Patient Positioning; Pneumonia, Viral; Prone Position; Respiratory Distress Syndrome; Respiratory System Agents; SARS-CoV-2
PubMed: 32505756
DOI: 10.1016/j.accpm.2020.05.013 -
Anaesthesia, Critical Care & Pain... Aug 2020
Topics: Almitrine; Betacoronavirus; COVID-19; Coronavirus Infections; Humans; Nitric Oxide; Oxygen Consumption; Pandemics; Pneumonia, Viral; Respiratory Distress Syndrome; Respiratory System Agents; Retrospective Studies; SARS-CoV-2; Vasoconstrictor Agents
PubMed: 32505755
DOI: 10.1016/j.accpm.2020.05.014 -
Anaesthesia, Critical Care & Pain... Jun 2020
Topics: Almitrine; Betacoronavirus; COVID-19; Capillary Leak Syndrome; Coronavirus Infections; Humans; Hypoxia; Lung; Lung Compliance; Pandemics; Patient Positioning; Pneumonia, Viral; Positive-Pressure Respiration; Pulmonary Circulation; Pulmonary Edema; Respiratory Mechanics; SARS-CoV-2; Switzerland; Tomography, X-Ray Computed; Vasoconstriction; Vasoconstrictor Agents
PubMed: 32305591
DOI: 10.1016/j.accpm.2020.04.003