I have not seen this issue discussed here. The term is new to me but about a month ago a biochemist friend told me that COVID had an auto-immune component that was very serious. Assume this to be a somewhat similar.

Also of interest is this comment in a recent article:

Quote:

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The next thing weird about COVID-19 is that the very old in our ICU died in a few days and we are left with 50- to 70-year-olds who stay on the ventilator for weeks. We are totally at the mercy of this disease, watching the lungs get much better and then the next day much worse.

It basically doesn't matter what we do. A few recover in six or seven days and go off to live their lives. Others show no unified trend of improvement two weeks into their medically induced coma. Those are the patients that stick to our ICU and load the census.

Even though there are fewer new patients with the illness, more beds are taken up because those few who come in seem to never leave. It's relentless work that feels futile because they pass away in arbitrary ways.

https://thefederalist.com/2020/05/08/icu-doctor-what-i-wish-people-knew-about-coronavirus/

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Comments from professionals appreciated.

I had more or less given up on 2 patients with covid as described above. Both in 60's, one obese and comorbidities, the other no other issues. I probably would have pushed for trach or withdrawal of care on both of them prior to this but no surgeon willing to trach. Both had stormy courses with renal failure requiring dialysis and on pressors for weeks. One was vented > 30 days and the other > 20 but both are now extubated and at ltac. Encouraging but also informative that these people will stack up in icu and there is no rushing it. They also have all the debility of surviving critical illness which is another challenge in and of itself .

If memory serves, I believe the poster Marcus Aurelius has had success using tocilizumab in these scenarios. Including at least one that was borderline miraculous.

Did a specific treatment turn your patients around?

No, One of them did receive convalescent plasma but was multiple weeks into hospital course at that point and I can't say I objectively saw any change in clinical course. Both received varying duration of moderate dose steroids after the point we felt the acute viral illness had passed. Both received Full dose anticoagulation based on rising d-dimer but both had it discontinued for different reasons.

Interesting. And frustrating to not have a treatment that can be shown to turn them around consistently.