Answer:
Most acute heart failure patients admitted in ICU when complicated with COVID-19, usually had hypotension and need inotropic and vasoconstrictive agents. There was no opportunity for ACEI or ARBs. It has been a great concern or controversy on ACEI or ARBs usage in mild COVID-19 patients with hypertension and chronic heart failure, since it may increase ACE2 receptor on basic research, but nobody knows right or wrong. My personal opinion is that, daily usage of ACEI/ARBs might increase the possibility of novel coronavirus infection theoretically, but for patients who already have confirmed COVID-19 for more than 3-4 weeks, it’s not a big concern. Because most patients will have swab tests negative and develop antibody at that time.
Answer:
Absolutely yes. We have observed several cases of that. Some patients were related with previous myocardial infarction or severe triple-vessels coronary artery disease. Some had cardiac arrest related with significant hypoxia when intubation. And some patients had severe hyperkalemia or hypokalemia.
Answer:
Yes, I share your concerns. I had a patient with a prolonged clinical course. He was on a non-invasive mechanical ventilator for about 30 days. At that time he had severe respiratory failure so that he couldn’t eat without the ventilator. Afterwards, we gave him enteral nutrition to reduce the weaning time as much as possible. After 10 days, we stopped the anti-virus medicine arbidol, prescribed only steroid and intravenous immunoglobulin, gradually he had no fever, and was weaned from respiratory support. Because he was 57 years old and strong, he was able to expectorate and clear his own secretions. As a side note, sputum of COVID-19 patients is very sticky and can’t be expectorated easily. We were thankful to be able to avoid intubation, which would increase the risk of ventilator-related injuries. So in summary, this virus infection is a self-limited process. During the process, mechanical ventilation is a tool to help the patients get through the acute danger of respiratory failure. With time, respiratory function should begin to improve, and the ventilator can be weaned gradually. So in my opinion, anti-virus medications are not the most important treatment. And up to this point, the results of remdesevir research haven’t been convincing.
Answer:
Previous study has shown that interferon-alpha-2b could inhibit the replication of COVID-19 (doi: https://doi.org/10.1101/2020.03.07.982264） and it has been recommended in Protocols for Diagnosis and Treatment of COVID-19. In our department, we regularly used the interferon-alpha-2b for most of patients in the beginning and found that interferon-alpha-2b was beneficial for COVID-19 therapy. However, interferon-alpha-2b should be performed in negative-pressure wards rather than general wards due to the possibility of aerosol transmission. Therefore, we only used it for intensive and critical patients later in the general wards since we found that combination use of the oral antiviral drugs, like Arbidol and Lianhua Qingwen, was enough to make the COVID-19 RNA negative for most patients and this could reduce the possibility of aerosol transmission.
Answer:
Swan catheterization was used in some critically ill patients who requiring ICU admission, to monitor the hemodynamics.
Answer:
Extremely low. Experience were exchanged among difference centers, and the survival rate is about 10-20% in all patients with ECMO. I don’t quite catch what you refer to C-A ECMO. I suppose it V-A ECMO. V-A ECMO is used for patients combined with respiratory failure and cardiac shock. But most ECMO cases received V-V mode.