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Of 1446 consecutive patients, 70 patients were intubated, died, or discharged within 24 hours after presentation and were excluded from the analysis. Of the remaining 1376 patients, during a median follow-up of 22.5 days, 811 (58.9%) received hydroxychloroquine (600 mg twice on day 1, then 400 mg daily for a median of 5 days); 45.8% of the patients were treated within 24 hours after presentation to the emergency department, and 85.9% within 48 hours. Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine (median ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen, 223 vs. 360). Overall, 346 patients (25.1%) had a primary end-point event (180 patients were intubated, of whom 66 subsequently died, and 166 died without intubation). In the main analysis, there was no significant association between hydroxychloroquine use and intubation or death (hazard ratio, 1.04, 95% confidence interval, 0.82 to 1.32). Results were similar in multiple sensitivity analyses.
Hydroxychloroquine-treated patients were more severely ill at baseline than those who did not receive hydroxychloroquine...
originally posted by: whereislogic
a reply to: Grimpachi
Basically the same trick as the VA study. It's written into the protocols to give it when it's too late, so you can then say: 'see, it doesn't work'. Add a bit of bad health care and neglect to it; no attempt to treat the cytokine storm (with immunosuppressors like prednisone along with antibiotica to counteract the bacteria that will join the party then; details available here ), while you perhaps do treat it in your group that isn't getting HCQ, and don't continue with HCQ on the HCQ group if it takes a bit longer than what the protocol says, stop their antibiotica (azithromycin) regime when they still need it or never add it in the first place, don't give them Vitmanin C and zinc at least, no HFNC, CPAP or BiPAP, but straight to the closed system intubation with badly managed pressures, etc.:
We examined the association between hydroxychloroquine use and intubation or death at a large medical center in New York City.
Respiratory symptoms (SOB; hypoxia- requiring N/C ≥ 4 L min: admit to ICU):
Essential Treatment (dampening the STORM)
1.Methylprednisolone 80 mg loading dose then 40mg q 12 hourly for at least 7 days and until transferred out of ICU. In patients with an increasing CRP or worsening clinical status increase the dose to 80mg q 12 hourly, then titrate down as appropriate.
2.Ascorbic acid (Vitamin C) 3g IV q 6 hourly for at least 7 days and/or until transferred out of ICU. Note caution with POC glucose testing (see below).
3.Full anticoagulation: Unless contraindicated we suggest FULL anticoagulation (on admission to the ICU) with enoxaparin, i.e 1 mg kg s/c q 12 hourly (dose adjust with Cr Cl < 30mls/min). Heparin is suggested with CrCl < 15 ml/min. Alternative approach: Half-dose rTPA: 25mg of tPA over 2 hours followed by a 25mg tPA infusion administered over the subsequent 22 hours, with a dose not to exceed 0.9 mg/kg followed by full anticoagulation.
Note: A falling SaO2 despite respiratory symptoms should be a trigger to start anti-inflammatory treatment (see Figure 2).
Note: Early termination of ascorbic acid and corticosteroids will likely result in a rebound effect with clinical deterioration (see Figure 3).
[Figure 2. Timing of the initiation of anti-inflammatory therapy]
Additional Treatment Components (the Full Monty)
4.Melatonin 6-12 mg at night (the optimal dose is unknown).
5.Famotidine 40mg daily (20mg in renal impairment)
6.Vitamin D 400u PO daily
7.Magnesium: 2 g stat IV. Keep Mg between 2.0 and 2.4 mmol/l. Prevent hypomagnesemia (which increases the cytokine storm and prolongs Qtc).
8.Optional: Azithromycin 500 mg day 1 then 250 mg for 4 days (has immunomodulating properties including downregulating IL-6; in addition, Rx of concomitant bacterial pneumonia).
9.Optional: Atorvastatin 40-80 mg/day. Of theoretical but unproven benefit. Statins have been demonstrated to reduce mortality in the hyper-inflammatory ARDS phenotype. Statins have pleotropic anti-inflammatory, immunomodulatory, antibacterial and antiviral effects. In addition, statins decrease expression of PAI-1
10.Broad-spectrum antibiotics if superadded bacterial pneumonia is suspected based on procalcitonin levels and resp. culture (no bronchoscopy). Due to the paradox of hyperinflammation and immune suppression (a major decrease of HLA-DR on CD14 monocytes) secondary bacterial infection is not uncommon.
11.Maintain EUVOLEMIA (this is not non-cardiogenic pulmonary edema). Due to the prolonged “symptomatic phase” with flu-like symptoms (6-8 days) patients may be volume depleted. Cautious rehydration with 500 ml boluses of Lactate Ringers may be warranted, ideally guided by non-invasive hemodynamic monitoring. Diuretics should be avoided unless the patient has obvious intravascular volume overload. Avoid hypovolemia.
12.Early norepinephrine for hypotension.
13.Escalation of respiratory support (steps); Try to avoid intubation if at all possible, (see Figure 4)
•Accept “permissive hypoxemia” (keep O2 Saturation > 84%); follow venous lactate and Central Venous O2 saturations (ScvO2) in patents with low arterial O2 saturations
•N/C 1-6 L/min
•High Flow Nasal canula (HFNC) up to 60-80 L/min
•Trial of inhaled Flolan (epoprostenol)
•Attempt proning (cooperative repositioning-proning)
•Intubation ... by Expert intubator; Rapid sequence. No Bagging; Full PPE. Crash/emergency intubations should be avoided.
•Volume protective ventilation; Lowest driving pressure and lowest PEEP as possible. Keep driving pressures < 15 cmH2O.
•Moderate sedation to prevent self-extubation
•Trial of inhaled Flolan (epoprostenol)
There is widespread concern that using HFNC could increase the risk of viral transmission. There is however, no evidence to support this fear. HFNC is a better option for the patient and the health care system than intubation and mechanical ventilation. CPAP/BiPAP may be used in select patients, notably those with COPD exacerbation or heart failure.
The study, the first randomized, placebo-controlled trial, which is considered the “gold standard” in science, looked at 821 people in the United States and Canada who had been exposed to the coronavirus.
The researchers, led by Dr. David Boulware, an infectious disease researcher at the University of Minnesota, said the drug was given to 414 people for five days while 407 got a placebo. Nearly 80% of the patients reported a high-risk exposure to a confirmed Covid-19 contact.
About 12% of the people who were given the malaria drug developed Covid-19, compared with 14% who did not receive the drug, according to the study’s findings, which included health-care workers and people close to those with Covid-19. They said side effects were more common with those who took hydroxychloroquine, but there were no “serious” adverse reactions. Results were no different for those using zinc and vitamin C, the researchers said.
No deaths were reported. About three-quarters of the patients had no underlying health conditions, according to the study, while the rest had reported hypertension, asthma or diabetes.
originally posted by: Grimpachi
a reply to: whereislogic
...There are dozens of other trials ongoing with HCQ I will continue to post the results as they come in be it good or bad.