High‑flow nasal cannula oxygenation and tocilizumab administration in patients critically ill with COVID‑19: A report of three cases and a literature review
Andrea Marıno, Alessio Pampaloni, Daniele Scuderi, Federica Cosentino, Vittoria Moscatt, Manuela Ceccarelli, Maria Gussio, Benedetto Maurizio Celesia, Roberto Bruno, Savino Borraccino, Giuseppe Nunnari, Bruno Cacopardo
Abstract
Since late 2019, SARS‑CoV2 has spread worldwide, leading the WHO to declare a pandemic state. Italy was deeply affected by the virus, particularly North Italy. Several molecules have been tested for the treatment of coronavirus disease (COVID‑19), comparing the treatment efficacy and collateral effects. To date, no antiviral drugs have been approved for the treatment of the COVID‑19 viral phase or for the inflammatory phase. Undoubtedly, oxygen support plays a key role in the management of patients affected by this virus. The present study reports the cases of 3 patients critically ill with COVID‑19. Despite antiviral therapy, their clinical conditions deteriorated a few days following admission, particularly as regards respiratory performance, together with chest X‑ray findings and arterial blood gas parameters. The levels of inflammatory markers were also elevated. The patients were treated with high‑flow nasal cannula (HFNC) oxygenation along with a double dose of tocilizumab. A few days following HFNC and tocilizumab administration, the respiratory rates and arterial blood gas data were ameliorated along with chest X‑ray results. The use of HFNC was then slowly reduced until it was terminated, with the patients achieving a successful discharge. On the whole, as presented herein, it is indisputable more data and guidelines for COVID‑19 therapies are warranted in order to guide clinicians as to the appropriate clinical treatment which will guarantee an optimal therapeutic response.