Background COVID-19 associated critical illness characterized by rapidly evolving acute respiratory failure (ARF) can develop, especially on the grounds of hyperinflammation. Aim and methods A case-series of 61 patients admitted to our intensive care unit (ICU) between August 12 and September 12, 2020 with confirmed COVID-19 pneumonia and rapidly evolving ARF requiring oxygen support therapy and/or mechanical ventilation was retrospectively analyzed. We examined whether intravenous administration of tocilizumab, a monoclonal interleukin-6 receptor antibody, was associated with improved outcome. All patients received empiric antivirals, dexamethasone 6 mg/day for 7 days, antibiotics, and prophylactic anticoagulation. Tocilizumab was administered at a dosage of 8 mg/kg [two consecutive intravenous infusions 12 h apart]. Outcome measures such as mortality on day-14, ICU length of stay, and rate of nosocomial acquired bacterial infections were also analyzed. Results: Patients were males (88.2%) aged 51 [interquartile range (IQR): 42.5–58.75)], with admission Acute Physiology and Chronic Health Evaluation (APACHE) 4 score of 53 (IQR: 37.75–72.5), and had more than one comorbidity (62.3%). On admission, twenty nine patients (47.5%) were mechanically ventilated, and thirty two patients (52.5%) were receiving oxygen therapy. No serious adverse effects due to tocilizumab therapy were recorded. However, twelve patients (19.6%) developed nosocomial acquired infections. ICU length of stay was 13 (IQR: 9–17) days, and mortality on day-14 was 24.6%. Six patients were shifted to other hospitals but were followed-up. The overall mortality on day-30 was 31.1%. Non-mechanically ventilated patients had higher survival rates compared to mechanically ventilated patients although results were not significant [hazards ratio = 2.6 (95% confidence intervals: 0.9–7.7), p = 0.08]. Tocilizumab did not affect the mortality of critically ill COVID-19 patients. Conclusion Tocilizumab could be an adjunct safe therapy in rapidly evolving COVID-19 pneumonia and associated critical illness. Highlights • Rapidly evolving respiratory failure is a hallmark of COVID-19-critical illness. • Tocilizumab could be an adjunct safe therapy in critically ill COVID-19 patients. • Tocilizumab did not affect the mortality of COVID-19 critically ill patients. • The prevalence of bacterial infections post-tocilizumab therapy was 19.8%.
【저자키워드】 COVID-19 pneumonia, mechanical ventilation, Tocilizumab, Acute respiratory failure, 【초록키워드】 COVID-19, Dexamethasone, therapy, Respiratory failure, Mortality, anticoagulation, intensive care, Pneumonia, antibody, antivirals, hospital, nosocomial, Comorbidity, Antibiotics, outcome, Prophylactic, ICU, Prevalence, infections, Critically ill, hyperinflammation, Physiology, male, Patient, Oxygen therapy, Bacterial infection, survival rate, Admission, Critical, critically ill patients, COVID-19 patients, monoclonal, interleukin-6 receptor, administration, Safe, intravenous, chronic, intravenous infusion, adverse effect, not significant, overall mortality, dosage, measure, tocilizumab therapy, mechanically ventilated, hallmark, oxygen support, Administered, analyzed, develop, examined, nine, receiving, characterized, not affect, ARF, were recorded, had more, mechanically ventilated patient, ventilated patient, 【제목키워드】 COVID-19, Treatment, Pneumonia, Critical, retrospective, case sery,