Janikowska Agata, Soukup Jens, Pliquett Rainer U, Abdel-Rahim Rabah
Department of Nephrology and Diabetology, Carl-Thiem Hospital, Cottbus, Germany.
Clinic for Anesthesiology, Intensive Therapy and Palliative Medicine, Carl-Thiem Hospital, Cottbus, Germany.
J Inflamm Res. 2022 Feb 3;15:715-722. doi: 10.2147/JIR.S344028. eCollection 2022.
We present 2 cases of severe Covid-19 with comorbidities (arterial hypertension, obesity, diabetes mellitus) treated with membrane-based therapeutic plasma exchanges in combination with a short-term high-dose immunosuppressive therapy. The therapy has been initiated in an attempt to alleviate the prevalent cytokine storm and to prevent intubation and invasive mechanical ventilation, when a long-term nasal oxygen therapy with a maximum flow rate of 8L/min was insufficient to achieve an adequate oxygenation. Even though patient 2 had to be intubated after the 4th cycle of plasmapheresis due to the exhaustion of the respiratory muscles and the subsequent acquired sepsis with a microbiological evidence of a mixed bacterial-fungal infection, both patients showed a good response to treatment, including improvement of laboratory and radiological findings. To our knowledge, this combination of therapeutic plasma exchange with a high-dose steroid therapy has not been reported previously.
我们报告了2例患有合并症（动脉高血压、肥胖症、糖尿病）的重症新型冠状病毒肺炎患者，采用基于膜的治疗性血浆置换联合短期大剂量免疫抑制疗法进行治疗。当最大流速为8L/min的长期鼻导管吸氧疗法不足以实现充分氧合时，启动该疗法旨在缓解普遍存在的细胞因子风暴，并防止插管和有创机械通气。尽管患者2在第4次血浆置换循环后因呼吸肌衰竭以及随后出现的混合细菌-真菌感染的微生物学证据而不得不插管，但两名患者对治疗均表现出良好反应，包括实验室检查和影像学检查结果的改善。据我们所知，这种治疗性血浆置换与大剂量类固醇疗法的联合应用此前尚未见报道。
