Polymyxin B hemoperfusion therapy and extracorporeal CO2 removal in a patient with COVID-19: A case report

Abstract

Introduction: In December 2019, an outbreak of pneumonia caused by a novel coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) quickly spread and the corona virus disease 2019 (COVID-19) became a pandemic. We report on a 54-year-old patient with SARS-CoV-2 infection suffering from septic shock due to nosocomial infection and pulmonary derangement caused by SARS-CoV-2. The patient was treated with polymyxin B hemoperfusion (PMX-HP), a blood purification therapy against septic shock, followed by continuous low flow extracorporeal CO2 removal therapy. Case Report: A 54-year-old man was hospitalized for coronavirus disease 2019 (COVID-19). Chest computed tomography (CCT) showed extensive non-segmental ground glass opacity. Despite the initiation of standard therapy, respiratory failure progressed. After two days of polymyxin B hemoperfusion therapy (PMX-HP) with adjunctive corticosteroid for multi-resistant Gram-negative infection (Acinetobacter) the patient’s condition improved. In rapidly progressive COVID-19 cases with secondary infection, the early use of PMX-HP may avoid the need for mechanical ventilation by suppressing local inflammation of the lung. Conclusion: The concern of life-threatening bacterial infections in critically ill COVID-19 patients due to antibiotics resistance is high. Secondary bacterial infections may develop during or following COVID-19 infection. The use of PMX-HP in septic shock patients has resulted in decreased dependency on ventilators, which is a serious issue during this COVID-19 pandemic. Combined and less invasive approaches might be considered in COVID-19 patients with multiple organ failure (MOF).