The Combination of Tocilizumab and Methylprednisolone Along With Initial Lung Recruitment Strategy in Coronavirus Disease 2019 Patients Requiring Mechanical Ventilation: A Series of 21 Consecutive Cases

• Published in: Critical care explorations Vol. 2; no. 6; p. e0145
• Main Authors: Hazbun, Munir E, Faust, Andrew C, Ortegon, Anthony L, Sheperd, Lyndsay A, Weinstein, Gary L, Doebele, Rebecca L, Weinmeister, Kenney D, Liddell, Allison M, Feldman, Mark
• Format: Journal Article
• Language: English
• Published: United States Wolters Kluwer Health 01.06.2020
• Subjects: Single-Center Quality Improvement Report; respiratory distress syndrome; artificial respiration; cytokine release syndrome; glucocorticoids; coronavirus disease 2019; viral pneumonia
• ISSN: 2639-8028; 2639-8028
• DOI: 10.1097/CCE.0000000000000145

To describe the outcomes with use of a combination of tocilizumab and methylprednisolone administered around the time of endotracheal intubation in patients with confirmed coronavirus disease 2019-associated hypoxemic respiratory failure requiring mechanical ventilation. Retrospective chart review. Twenty-one consecutive patients with confirmed coronavirus disease 2019-associated hypoxemic respiratory failure requiring mechanical ventilation. Initial ventilator parameters were positive end-expiratory pressure 14 cm H o and target plateau pressure 29 cm H o to maximize lung recruitment. Methylprednisolone (125 mg every 6hr for 24 hr with tapering to 60 mg every 12 hr) was administered shortly after patients were intubated (median 11 hr after intubation). No patient in the cohort died while hospitalized (mortality, 0%; 95% CI, 0%-18%) and 18 patients have been discharged from the acute care setting. Twenty of 21 patients (95%) have been liberated from mechanical ventilation after a median duration of 8 days (range, 4-30 d). Following 48 hours of methylprednisolone, the A-a o gradient decreased from 455 ± 103 to 228 ± 109 mm Hg (difference 227 ± 108 mm Hg; < 0.01). Our positive experience with tocilizumab in combination with methylprednisolone started early after endotracheal intubation may be one avenue for reducing the morbidity and mortality seen with severe coronavirus disease 2019 and merits further exploration in clinical studies.