Blood Purification in Severe and Critical COVID-19 Patients: A Case Series of 5 Patients

Severe pneumonia combined with septic shock caused by community-acquired methicillin-resistant Staphylococcus aureus treated with veno-venous ECMO: A case report

RATIONALE

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) pneumonia is a severe and rapidly progressing infection that can lead to acute respiratory distress syndrome and septic shock. The use of venovenous extracorporeal membrane oxygenation (ECMO) may improve outcomes in critically ill patients who fail conventional mechanical ventilation.

PATIENT CONCERNS

Two female patients, aged 14 and 32 years, presented with fever and cough before hospital admission. Both patients rapidly developed severe respiratory distress and hemodynamic instability, raising concerns for a life-threatening infection.

DIAGNOSES

Both patients were diagnosed with severe pneumonia caused by CA-MRSA, complicated by acute respiratory distress syndrome and septic shock. Microbiological testing confirmed the presence of CA-MRSA in respiratory samples.

INTERVENTIONS

The patients were initially treated with broad-spectrum anti-infective agents, including linezolid, targeting CA-MRSA. Due to the failure of conventional mechanical ventilation to maintain adequate oxygenation, venovenous ECMO was initiated to support respiratory function. The patients also received hemodynamic support and other adjunctive therapies for septic shock.

OUTCOMES

Following the initiation of ECMO and targeted antibiotic therapy, both patients showed significant clinical improvement. Lung function recovered well, and they were successfully weaned off ECMO and mechanical ventilation. Both patients were eventually discharged with favorable outcomes.

LESSONS

CA-MRSA pneumonia can progress rapidly to severe respiratory failure and septic shock, necessitating aggressive interventions. Venovenous ECMO, combined with timely and appropriate antibiotic therapy can be life-saving in such cases. This report highlights the importance of early recognition, multidisciplinary management, and the potential benefits of ECMO in severe CA-MRSA pneumonia. It serves as a clinical reference for the treatment of similar cases.

COVID-19 and Acute Kidney Injury: A Systematic Review

Introduction

Acute kidney injury (AKI) has been associated with an increased mortality rate among hospitalized patients with Coronavirus disease 2019 (COVID-19). The current review aimed to evaluate the symptoms, complications, and treatments performed to manage AKI in patients with COVID-19.

Methods

We searched PubMed/Medline, Web of Science, and Embase for the relevant scientific literature published up to February 1, 2022. The following keywords were used: “COVID-19”, “SARS-CoV-2”, and “Acute kidney injury”.

Results

Forty-four studies with a total number of 114 COVID-19 patients with AKI (Mean age: 53.6 years) were included in our systematic review. The most common comorbidities in patients with COVID-19 suffering from AKI were the history of diabetes, hypertension, and hyperlipidemia. Twelve out of the 44 included studies reported a history of chronic kidney disease (CKD) in this group of patients. Focal segmental glomerulosclerosis (FSGS) and acute tubular necrosis (ATN) were the most common pathological evidence. The average length of hospital stay was 19 days, and the average duration of need for mechanical ventilation was 3 days.

Conclusions

The current systematic review shows that AKI frequently complicates the course of COVID-19 hospitalizations and is associated with increased severity of illness, prolonged duration of hospitalization, and poor prognosis. Given the extent of the adverse impact of AKI, early detection of comorbidities and renal complications is essential to improve the outcomes of COVID-19 patients.

Case Report: Successful Treatment of a Child With COVID-19 Reinfection-Induced Fulminant Myocarditis by Cytokine-Adsorbing oXiris® Hemofilter Continuous Veno-Venous Hemofiltration and Extracorporeal Membrane Oxygenation

BACKGROUND

Indirect cardiomyocyte damage-related hyperinflammatory response is one of the key mechanisms in COVID-19-induced fulminant myocarditis. In addition to the clinical benefit of using cytokines absorption hemofiltration, the effectiveness of instituting veno-arterial extracorporeal membrane oxygenation (VA-ECMO) support for cardiac compromise has been reported. However, current literature enunciates a paucity of available data on the effectiveness of these novel modalities.

CASE PRESENTATION

We reported a 9-year-old boy with recurrent COVID-19 infection-causing fulminant myocarditis, who was treated successfully by using novel modalities of oXiris ^® hemofilter continuous venovenous hemofiltration (CVVH) and VA-ECMO. The patient made a full recovery without any sequelae.

CONCLUSION

We conclude that the novel highly-absorptive hemofilter CVVH and VA-ECMO may be effective treatment modalities in managing SARS-CoV-2-induced fulminant myocarditis. Our report highlights the need for further well-designed investigations to confirm this extrapolation.