Expert recommendations on blood purification treatment protocol for patients with severe COVID-19

Abstract

Coronavirus disease (COVID-19) was first diagnosed in Wuhan in December 2019. The World Health Organization defined the subsequent outbreak of COVID-19 worldwide as a public health emergency of international concern. Epidemiological data indicate that at least 20% of COVID-19 patients have severe disease. In addition to impairment of the respiratory system, acute kidney injury (AKI) is a major complication. Immune damage mediated by cytokine storms and concomitant AKI is a key factor for poor prognosis. Based on previous experience of blood purification for patients with severe acute respiratory syndrome and Middle East respiratory syndrome combined with clinical front-line practice, we developed a blood purification protocol for patients with severe COVID-19. This protocol is divided into four major steps. The first step is to assess whether patients with severe COVID-19 require blood purification. The second step is to prescribe a blood purification treatment for patients with COVID-19. The third step is to monitor and adjust parameters of blood purification. The fourth step is to evaluate the timing of discontinuation of blood purification. It is expected that blood purification will play a key role in effectively reducing the mortality of patients with severe COVID-19 through the standardized implementation of the present protocol.

Keywords: Blood purification treatment; COVID-19; SARS-CoV-2.

Fig. 1

Flow chart of blood purification treatment for patients with severe COVID-19. COVID-19: coronavirus disease 2019; SCUF: slow continuous ultrafiltration; AKI: acute kidney injury; CVVH: continuous venovenous hemofiltration; CVVHDF: continuous venovenous hemodiafiltration; HVHF: high volume blood filtration; PE: plasma exchange; HP: blood perfusion; CPFA: continuous plasma filtration absorption; ECMO: extracorporeal membrane oxygenation; CRRT: continuous renal replacement therapy; SIRS: systemic inflammatory response syndrome; IL-6: interleukin 6.