A Fourteen-day Experience with Coronavirus Disease 2019 (COVID-19) Induced Acute Respiratory Distress Syndrome (ARDS): An Iranian Treatment Protocol

Document Type : Research article

Authors

1 Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3 Clinical Tuberculosis and Epidemiology Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4 Student Research Committee, Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

COVID-19 is currently causing concern in the medical community as the virus is spreading
around the world. It has a heavy global burden, particularly in low-income countries. The clinical
spectrum of COVID-19 pneumonia ranges from mild to critically ill cases and Acute Respiratory
Distress Syndrome. An expert panel was held and an internal protocol was developed to manage
the COVID-19 induced ARDS according to WHO recommendations and NIH guidelines.
Different therapeutic regimens were employed on this protocol based on the ARDS severity and
the patients’ special characteristics. The mortality rate, the rate of survivors, and non-survivors
were reported. Of the 231 suspected cases of COVID-19 admitted to the hospital during two
weeks, 72 patients were admitted to ICU with diagnosis confirmed by RT-PCR. In total, mortality
in the ICU was 25% (n = 18) among ARDS patients over two weeks. COVID-19 induced ARDS
is a major concern. The rapid progression of ARDS needs specific protocol based on patients’
characteristics and rapid action.

Graphical Abstract

A Fourteen-day Experience with Coronavirus Disease 2019 (COVID-19) Induced Acute Respiratory Distress Syndrome (ARDS): An Iranian Treatment Protocol

Keywords

Main Subjects



(1) Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, ZhangX and Zhang L. Epidemiological and clinical
characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet (2020) 395: 507-13.
(2) Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, Gattinoni L, van Haren F, Larsson A, McAuley DF, Ranieri M, Rubenfeld G, Thompson
BT, Wrigge H, Slutsky AS, Pesenti A, Investigators ftLS and Group tET. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA (2016) 315: 788-800.
(3) The World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. 2020. Available from: URL: https://www. who.int/publications-detail/clinicalmanagementof-severe-acute-respiratory-infection-when-novelcoronavirus-(ncov)-infection-is-suspected.
(4) Colson P, Rolain JM, Lagier JC, Brouqui P and Raoult D. Chloroquine and hydroxychloroquine as available weapons to fight COVID-19. Int. J. Antimicrob. Agents (2020) 2020: 105932.
(5) Sahraei Z, Shabani M, Shokouhi S and Saffaei A. Aminoquinolines against Coronavirus disease 2019 (COVID-19): chloroquine or hydroxychloroquine. Int. J. Antimicrob. Agents (2020) 2020: 105945.
(6) Villar J, Ferrando C, Martínez D, Ambrós A, Muñoz T, Soler JA, Aguilar G, Alba F, GonzálezHigueras E, Conesa LA, Martín-Rodríguez C, Díaz-Domínguez FJ, Serna-Grande P, Rivas R, Ferreres J, Belda J, Capilla L, Tallet A, Añón JM, Fernández RL, González-Martín JM, Aguilar G, Alba F, Álvarez J, Ambrós A, Añón JM, Asensio MJ, Belda J, Blanco J, Blasco M, Cachafeiro L, del Campo R, Capilla L, Carbonell JA, Carbonell N, Cariñena A, Carriedo D, Chico M, Conesa LA, Corpas R, Cuervo J, Díaz-Domínguez FJ, Domínguez-Antelo C, Fernández L, Fernández RL, Ferrando C, Ferreres J, Gamboa E, GonzálezHigueras E, González-Luengo RI, González-Martín JM, Martínez D, Martín-Rodríguez C, Muñoz T, Ortiz Díaz-Miguel R, Pérez-González R, Prieto AM, Prieto I, Rivas R, Rojas-Viguera L, Romera MA, Sánchez-Ballesteros J, Segura JM, Serna-Grande P, Serrano A, Solano R, Soler JA, Soro M, Tallet A and Villar J. Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. Lancet Respir. Med. (2020) 8: 267-76. 36 Jamaati HR et al. / IJPR (2020), 19 (1): 31-36
(7) Lee KY. Pneumonia, acute respiratory distress syndrome, and early immune-modulator therapy. Int. J. Mol. Sci. (2017) 18: E388.
(8) Pyrc K, Bosch BJ, Berkhout B, Jebbink MF, Dijkman R, Rottier P and van der Hoek L. Inhibition of human coronavirus NL63 infection at early stages of the replication cycle. Antimicrob. Agents Chemother. (2006) 50: 2000-8.
(9) Henry BM. COVID-19, ECMO, and lymphopenia: a word of caution. Lancet Respir. Med. (2020) 2020: 1.