First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
First patient with cytokine storm treated with tociluzimab at my hospital..........
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Last: 4 yr ago by milkman00
I'm sure that was exciting!Quote:
Patient self extubated
Can you explain why this drug was tried?
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IL-6 thought to drive the cytokine storm of severe COVID-19. This drug blocks IL-6 effects.
IL-6 thought to drive the cytokine storm of severe COVID-19. This drug blocks IL-6 effects.
I presume self extubation is not typical protocol?
I would very likely do something like that....unfortunately.
I would very likely do something like that....unfortunately.
Yes. Not planned. happens not infrequently. Instead of re-intubation he was observed off vent and has flown.
It gives you hairy palms.MiMi said:I'm sure that was exciting!Quote:
Patient self extubated
Self extubation isn't ideal (ever) but the saying around here is that it means they've got some fight in them.
What is the long term prognosis for someone that recovers from ARDS? Are the lungs permanently damaged? Will they need O2 support long term?
What was his peak NLR?
For non COVID-19 ARDS (mortality across the board 40%) survivors - studied with lung function testing one year out. Small numbers of pt (5% or less) have some decrement in DLCO (ability of alveoli to absorb O2). Otherwise normal lung function. COVID-19 ARDS is unclear. Reports out of China that some pts have pulmonary fibrosis. To be determined.
Marcus Aurelius said:
First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
If this turns out to work when is the best time to use it?
When does this Interleukin-6 start to spike?
High. Markedly improved after Toci. Check PM.
NMKeegan99 said:
What was his peak NLR?
That's impressive....but a self-intubation would be even more impressive.
That's awesome news though - even if only anecdotal and doesn't prove to be reliable, I'm sure it was good for you to see some great news in the midst of all of this.
That's awesome news though - even if only anecdotal and doesn't prove to be reliable, I'm sure it was good for you to see some great news in the midst of all of this.
Usually symptom day 7-9. As inflammatory markers rise dramatically. Oxygenation worsens and other organ dysfunction begins.
Fantastic news
So did patient self extubate with the cuff inflated? If so impressive and dangerous.
Aurelius:Marcus Aurelius said:
First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
Are you interested in listening in on a webinar tomorrow? I will send login info if you wish. It is fairly limited. I am a lolpoor, but I will give staff permission to have you email me if you are interested. Hope my linkey-thing works.
Keep up the great work.
UGA and Wuhan Covid Management Lessons Learned Webinar
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Gimme a rain check. I have patients tomorrow AM. Thanks for invite.
I'm going to pretend I understand everything you all are talking about.
BTHO this **** ags.
BTHO this **** ags.
oldschoolcat said:
I presume self extubation is not typical protocol?
I would very likely do something like that....unfortunately.
It's definitely not rare.
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Marcus Aurelius said:
First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
This has been my experience. Only had one die who got an IL-6 inhibitor and they probably got it too late.
Everyone else has either gotten better or is getting better. The patient I spoke about over the weekend on the brink of death was extubated today after 7 days on the vent, 6 days after getting toci. One of the most surprising turnarounds in my time in medicine.
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MiMi said:I'm sure that was exciting!Quote:
Patient self extubated
Yeah. That was the best part of the story
So they were intubated but conscious, and said "F this" and pulled the tube out? wow.MiMi said:I'm sure that was exciting!Quote:
Patient self extubated
Great news. How much toci did the patient need over that time or was it a one time application?Infection_Ag11 said:Marcus Aurelius said:
First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
This has been my experience. Only had one die who got an IL-6 inhibitor and they probably got it too late.
Everyone else has either gotten better or is getting better. The patient I spoke about over the weekend on the brink of death was extubated today after 7 days on the vent, 6 days after getting toci. One of the most surprising turnarounds in my time in medicine.
I find it kind of interesting the amount of fascination in the self-extubation part of the anecdote. But I guess if you don't see it a alot it's a scary thought. This patient a strong male. Even with propofol, precedex, fentanyl drips etc they can manage to yank it out.
20 or above?Marcus Aurelius said:
High. Markedly improved after Toci. Check PM.
Let me know when the english translation of the OP is available.
The doctor tried a new drug on a patient in a bad stage of the disease. It worked so well the patient decided to yank his breathing tube out. Seemingly the patient sounds like he will recover.Flexbone said:
Let me know when the english translation of the OP is available.
Flexbone said:
Let me know when the english translation of the OP is available.
Translation:
Inflammation is bad. Lung inflammation caused by covid-19 is killing people. This medicine helps block the body chemical that is causing the inflammation. The patient got it and is doing better.
In this case, the patient had a tube down his throat. Despite medicine to keep him relaxed, he managed to grab hold of the tube and yank it out. He's breathing okay without the tube and they will leave it out.
ham98 said:Great news. How much toci did the patient need over that time or was it a one time application?Infection_Ag11 said:Marcus Aurelius said:
First experience with it. Patient with COVID-19 cytokine storm- typical ARDS high support vent. Fever, all typical inflammatory numbers climbing. Toci (IL-6 inhibitor) at 4mg/kg (to try to preserve drug - normal 8mg/kg dose) given. Next day. All inflammatory markers markedly lower. Patient self extubated and has remained off the vent with O2 support. Promising. Pure anecdote but thought I'd share.
This has been my experience. Only had one die who got an IL-6 inhibitor and they probably got it too late.
Everyone else has either gotten better or is getting better. The patient I spoke about over the weekend on the brink of death was extubated today after 7 days on the vent, 6 days after getting toci. One of the most surprising turnarounds in my time in medicine.
Based on weight (and facility) it's 400-800 mg x1-2 doses. I'm giving one dose and then monitoring fever and labs. If still fevering consistently and inflammatory markers still worsening we're giving another dose 8-12 hours later.
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oneeyedag said:
So did patient self extubate with the cuff inflated? If so impressive and dangerous.
Exactly what I was thinking...still inflated? I've obviously never seen that in an EMS setting.
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