texags:
Marcus Aurelius12:29pAG
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.
‘patient self extubated’...
Aie.
The hell you say...Texans! :)
FRENCH HOSPITAL STOPS HYDROXYCHLOROQUINE TREATMENT FOR COVID-19 PATIENT OVER MAJOR CARDIAC RISK
https://www.newsweek.com/hydroxychloroquine-coronavirus-france-heart-cardiac-1496810
https://texags.com/forums/84/topics/3099401/50
Just saw this post myself. Tocilimuzab. I am beginning to hear some promising things on this. Probably still limited in availability., but seems to work better than hcq when patients are in critical condition.
Same doctor is getting mixed results with hcq, along with other docs...my guess it’s not the mixed regimen being recommended on this board.
https://texags.com/forums/84/topics/3101098/0
“1: A total of about 30 that I’ve been involved in the care of over the last 3 weeks, so I’ve probably given HCQ to roughly 23-25 patients off the top of my head
2: Most institutional algorithms recommend HCQ for moderate to severe disease, as does ours. GENERALLY, patients ill enough to get admitted are ill enough to get it. This usually means they have evidence of pneumonia and at least mild oxygen requirements. I had 4 who probably shouldn’t have been admitted and didn’t get HCQ due to either being low risk with mild disease (ie very young without hypoxia) or having a contraindication to HCQ (congenital long QT syndrome). A couple ICU patients came in tubed already in full blown cytokine storm and we went straight to an IL-6 inhibitor. Other than that most are getting it.
3: HCQ/zinc (because it’s our institutional policy, but the zinc is pointless in most patients with normal diets)
4: Anecdotally it seems to make little to no difference. Most patients get better (and probably would have gotten better anyway), a few get worse and end up on remdesivir/siralumab/toci if possible. The ones who didn’t get it (and weren’t intubated from jump street) all did fine but again they had mild disease. Again anecdotal, but for severe disease I’ve had good results with the IL-6 inhibitors. Remdesivir seems to maybe help if given during the period when viral replication and primary pneumocyte destruction is still an active part of the disease process.
Again, none of this is based on the scientific method or objective data. Just merely my perception from a limited sample size.
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71 edit
Marcus AureliusIn reply to Infection_Ag11 • 7:26p, 4/8/20AG
Agree with this. Similar experience. I don’t think giving it to patients once they are sick enough to be admitted is beneficial. We are doing it however. The unanswered question, so repeatedly mentioned on here, is HCQ within 48 hrs of symptom onset. To limit viral replication. We shall see.
No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment.
Ditto on the self-extubating comments. That’s Chuck Norris level stuff there
cytokine storm
Marcus AureliusIn reply to aggie-beta • 1:20pAG
Usually symptom day 7-9. As inflammatory markers rise dramatically. Oxygenation worsens and other organ dysfunction begins.