Plasma exchange combined with plasma adsorption or dual plasma molecular adsorption, perfusion and filtration is recommended depending on the patient's situation. When performing ALSS, 2000 ml of plasma should be exchanged. Detailed operational procedures can be found in the expert consensus on the use of artificial liver blood purification system in the treatment of severe and critical novel coronavirus pneumonia.
ALSS significantly shortens the stay of critically ill patients in the intensive care unit of our hospital. Generally, the levels of serum cytokines such as IL-2/IL-4/IL-6/TNF-α are markedly reduced and oxygen saturation is significantly improved after ALSS.
Hypoxemia may occur due to respiratory failure caused israel number data by COVID-19. Treatment with oxygen supplements may correct hypoxemia, reversing secondary organ damage caused by respiratory failure and hypoxemia.
3.1 Oxygen therapy
Continuous monitoring of oxygen saturation during oxygen therapy
Not all patients necessarily have impaired oxygenation function at the onset of infection, but may show rapid deterioration of oxygenation over time. Therefore, continuous monitoring of oxygen saturation before and during oxygen therapy is recommended.
Prompt initiation of oxygen therapy
Oxygen therapy is not needed in patients with oxygen saturation (SpO2) greater than 93% or in patients without overt symptoms of respiratory distress without oxygen therapy. Oxygen therapy is strongly recommended in patients with symptoms of respiratory distress. It should be noted that some severely ill patients with PaO2/FiO2 < 300 had no overt symptoms of respiratory distress.
The goal of oxygen therapy treatment
is to maintain oxygen saturation (SpO2) at 93%-96% in patients without chronic respiratory failure and at 88%-92% in patients with chronic respiratory failure type Il. In particular, oxygen concentration should be increased to 92%-95% for patients whose SpO2 frequently falls below 85% during daily activities.
Oxygen Therapy Monitoring
PaO2/FiO2 is a sensitive and accurate indicator of oxygenation function. Stability and controllability of FiO2 are very important in patients with disease progression and PaO2/FiO2 below 300 mmHg. Controlled oxygen therapy is the preferred treatment method.
High-flow nasal cannula (HFNC) oxygen therapy is recommended for patients with the following conditions: SpO2 < 93%; PaO2/FiO2 < 300 mmHg (1 mmHg = 0.133 kPa); respiratory rate > 25 breaths per minute at bedside; or marked progression on chest radiography. Patients should wear a surgical mask during HFNC treatment. The airflow of HFNC oxygen therapy should be started at a low level and gradually increased to 40-60 L/min when PaO2/FiO2 is between 200-300 mmHg, so that patients do not feel obvious chest tightness and dyspnea. An initial flow of at least 60 L/min should be administered immediately to patients with obvious respiratory distress. Tracheal intubation of patients depends on the disease progression, systemic status, and complications in patients with a stable situation but a low oxygenation index (<100 mmHg). Therefore, a detailed assessment of the clinical condition of patients is very important before making a decision.
Tracheal intubation should be performed as early as possible in patients with an oxygenation index <150 mmHg, worsening respiratory distress symptoms, or multiorgan dysfunction within 1-2 hours after high-flow (60 L/min) and high-concentration (>60%) HFNC oxygen therapy.
Elderly patients (>60 years) with more complications or PaO2/FiO2 <200 mmHg should be treated in the intensive care unit.