Last ditch Efforts

3,468 Views | 4 Replies | Last: 2 yr ago by AgsMyDude
Texas Aggies 12
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70 year old patient was in ICU last week with Covid. Was given steroids and some type of new monoclonal medication originally designed for RA. They apparently only give 2 doses. The first dose was given last week and patient improved. Got out of ICU and was sent into a normal room.

1 week later his lung function isn't improving on airvo and slowly been increasing O2 supplemented. Doctors ran CT and no blood clot but shows Covid is still progressing and near "peak" terminology given by pulmonologist.

We found out today the 2nd dose of monoclonal was never given bc he was "improving" and moved out of ICU. The doctors said they feel like there is nothing left that can be done. We are a little perplexed how this has been handled and communication has been pretty lousy.

Kidney numbers are good at 1.2 and liver function good as well. He isn't on a vent and we just aren't positive all options have been exhausted. Since kidney function is okay would a course of remdesivir and giving the other dose of monoclonal dose at least be worth a shot?

Any other options we might at least try?
stamper
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AG
This is a tough spot and one that is encountered frequently.

There is not any strong evidence to use anything else in this situation.

Very unlikely that remdesivir would be helpful this late in the course.

Sometimes additional or higher dose steroids could be considered though there is not good evidence to support using them. We occasionally use the trend in inflammatory markers like the CRP or D-dimer to help decide if additional steroids should be considered. There are also downsides to longer courses of higher dose steroids that may need to be considered in certain patients.

I have seen patients in this situation for weeks and weeks that finally turn around.

Good luck!

Stringfellow Hawke
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AG
Transfer to a hospital with doctor that will actually treat patient.
bigtruckguy3500
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Honestly, other than high dose steroids, and possibly aggressive diuretic therapy, there's not a ton that can be done after his body is making plenty of his own antibodies and he's cleared the virus.

Monoclonal antibodies don't do a lot after a certain point in time, because the patient already is producing their own antibodies that are tailor made to the specific strain of the virus. Saw one patient recently with unexplained shortness of breath. Was unvaccinated and had a minor cold about 3 weeks before coming to the ER. Only lasted a couple days. His PCR COVID test was negative. After 2-3 days in the ICU, they tested him for COVID antibodies, and they were sky high. CT scan of his lungs looked horrendous.

He was in his mid-70's.
AgsMyDude
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AG
Any update?
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