Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series
Objective To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure. Methods To be included in this retrospective case series, patients must h...
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| Veröffentlicht in: | Arthritis & rheumatology (Hoboken, N.J.) N.J.), 2020-12, Vol.72 (12), p.1990-1997 |
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| container_end_page | 1997 |
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| container_issue | 12 |
| container_start_page | 1990 |
| container_title | Arthritis & rheumatology (Hoboken, N.J.) |
| container_volume | 72 |
| creator | Navarro‐Millán, Iris Sattui, Sebastian E. Lakhanpal, Amit Zisa, Diane Siegel, Caroline H. Crow, Mary K. |
| description | Objective
To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure.
Methods
To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6‐liter nasal cannula or use of ≥95% oxygen by high‐flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation.
Results
Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation.
Conclusion
Our data suggest that anakinra could be beneficial in treating COVID‐19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID‐19 and symptoms of cytokine storm syndrome. |
| doi_str_mv | 10.1002/art.41422 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_7361793</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2464835906</sourcerecordid><originalsourceid>FETCH-LOGICAL-c5372-8fc8ad8225b95be9900bc062d07568f7aac238bc3fca5aa778d639508dc8dbe3</originalsourceid><addsrcrecordid>eNp1kc1KXDEYhkOxVLEuvIES6EYXM-ZnkpN0URjGnw4oFh3dhu_k5NTYM4kmZxR3XoLX6JU07aio0GyS8D08vB8vQpuUDCkhbAdSPxzREWMf0BrjTA4EI2Ll-U01XUUbOV-ScnRFJBGf0GoZEcYkW0NnZ9nh2OJxgN8-JMB9xD-Tu3Ghx0fOXkDwFjp8Xv6-g97HgH3ApwVIDk-Oz6e7j_cPVH_DYzyBojp1ybv8GX1soctu4-leR7P9vdnkx-Dw-GA6GR8OrOAVG6jWKmgUY6LWonZaE1JbIllDKiFVWwFYxlVteWtBAFSVaiTXgqjGqqZ2fB19X2qvFvXcNbaETNCZq-TnkO5MBG_eToK_ML_ijam4pJXmRbD1JEjxeuFyb-Y-W9d1EFxcZMNGVBOtOKUF_foOvYyLFMp2hZIjxYUmslDbS8qmmHNy7UsYSszfukypy_yrq7BfXqd_IZ_LKcDOErj1nbv7v8mMT2ZL5R-2Op4u</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2464835906</pqid></control><display><type>article</type><title>Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series</title><source>MEDLINE</source><source>Access via Wiley Online Library</source><source>Alma/SFX Local Collection</source><creator>Navarro‐Millán, Iris ; Sattui, Sebastian E. ; Lakhanpal, Amit ; Zisa, Diane ; Siegel, Caroline H. ; Crow, Mary K.</creator><creatorcontrib>Navarro‐Millán, Iris ; Sattui, Sebastian E. ; Lakhanpal, Amit ; Zisa, Diane ; Siegel, Caroline H. ; Crow, Mary K.</creatorcontrib><description>Objective
To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure.
Methods
To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6‐liter nasal cannula or use of ≥95% oxygen by high‐flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation.
Results
Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation.
Conclusion
Our data suggest that anakinra could be beneficial in treating COVID‐19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID‐19 and symptoms of cytokine storm syndrome.</description><identifier>ISSN: 2326-5191</identifier><identifier>EISSN: 2326-5205</identifier><identifier>DOI: 10.1002/art.41422</identifier><identifier>PMID: 32602262</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Aged ; Aged, 80 and over ; Antirheumatic Agents - therapeutic use ; Bacterial diseases ; Brief Report ; Coronaviridae ; Coronaviruses ; COVID-19 ; COVID-19 - drug therapy ; COVID-19 - therapy ; Cytokine Release Syndrome - drug therapy ; Cytokine Release Syndrome - therapy ; Cytokine storm ; Cytokines ; Failure ; Female ; Ferritin ; Fever ; Health services ; Humans ; Immunosuppressive agents ; Interleukin 1 receptor antagonist ; Interleukin 1 Receptor Antagonist Protein - therapeutic use ; Male ; Mechanical ventilation ; Medical materials ; Middle Aged ; Oxygen ; Patients ; Respiration, Artificial ; Respiratory diseases ; Respiratory failure ; Respiratory Insufficiency - drug therapy ; Respiratory Insufficiency - therapy ; Retrospective Studies ; Severe acute respiratory syndrome ; Severe acute respiratory syndrome coronavirus 2 ; Signs and symptoms ; Treatment Outcome ; Tubes ; Ventilation ; Viral diseases</subject><ispartof>Arthritis & rheumatology (Hoboken, N.J.), 2020-12, Vol.72 (12), p.1990-1997</ispartof><rights>2020, American College of Rheumatology</rights><rights>2020, American College of Rheumatology.</rights><rights>2020 American College of Rheumatology</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c5372-8fc8ad8225b95be9900bc062d07568f7aac238bc3fca5aa778d639508dc8dbe3</citedby><cites>FETCH-LOGICAL-c5372-8fc8ad8225b95be9900bc062d07568f7aac238bc3fca5aa778d639508dc8dbe3</cites><orcidid>0000-0002-3945-6828 ; 0000-0002-9540-6614 ; 0000-0001-6057-0070 ; 0000-0002-7881-2020</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1002%2Fart.41422$$EPDF$$P50$$Gwiley$$H</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1002%2Fart.41422$$EHTML$$P50$$Gwiley$$H</linktohtml><link.rule.ids>230,314,780,784,885,1417,27924,27925,45574,45575</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32602262$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Navarro‐Millán, Iris</creatorcontrib><creatorcontrib>Sattui, Sebastian E.</creatorcontrib><creatorcontrib>Lakhanpal, Amit</creatorcontrib><creatorcontrib>Zisa, Diane</creatorcontrib><creatorcontrib>Siegel, Caroline H.</creatorcontrib><creatorcontrib>Crow, Mary K.</creatorcontrib><title>Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series</title><title>Arthritis & rheumatology (Hoboken, N.J.)</title><addtitle>Arthritis Rheumatol</addtitle><description>Objective
To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure.
Methods
To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6‐liter nasal cannula or use of ≥95% oxygen by high‐flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation.
Results
Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation.
Conclusion
Our data suggest that anakinra could be beneficial in treating COVID‐19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID‐19 and symptoms of cytokine storm syndrome.</description><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Antirheumatic Agents - therapeutic use</subject><subject>Bacterial diseases</subject><subject>Brief Report</subject><subject>Coronaviridae</subject><subject>Coronaviruses</subject><subject>COVID-19</subject><subject>COVID-19 - drug therapy</subject><subject>COVID-19 - therapy</subject><subject>Cytokine Release Syndrome - drug therapy</subject><subject>Cytokine Release Syndrome - therapy</subject><subject>Cytokine storm</subject><subject>Cytokines</subject><subject>Failure</subject><subject>Female</subject><subject>Ferritin</subject><subject>Fever</subject><subject>Health services</subject><subject>Humans</subject><subject>Immunosuppressive agents</subject><subject>Interleukin 1 receptor antagonist</subject><subject>Interleukin 1 Receptor Antagonist Protein - therapeutic use</subject><subject>Male</subject><subject>Mechanical ventilation</subject><subject>Medical materials</subject><subject>Middle Aged</subject><subject>Oxygen</subject><subject>Patients</subject><subject>Respiration, Artificial</subject><subject>Respiratory diseases</subject><subject>Respiratory failure</subject><subject>Respiratory Insufficiency - drug therapy</subject><subject>Respiratory Insufficiency - therapy</subject><subject>Retrospective Studies</subject><subject>Severe acute respiratory syndrome</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Signs and symptoms</subject><subject>Treatment Outcome</subject><subject>Tubes</subject><subject>Ventilation</subject><subject>Viral diseases</subject><issn>2326-5191</issn><issn>2326-5205</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2020</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp1kc1KXDEYhkOxVLEuvIES6EYXM-ZnkpN0URjGnw4oFh3dhu_k5NTYM4kmZxR3XoLX6JU07aio0GyS8D08vB8vQpuUDCkhbAdSPxzREWMf0BrjTA4EI2Ll-U01XUUbOV-ScnRFJBGf0GoZEcYkW0NnZ9nh2OJxgN8-JMB9xD-Tu3Ghx0fOXkDwFjp8Xv6-g97HgH3ApwVIDk-Oz6e7j_cPVH_DYzyBojp1ybv8GX1soctu4-leR7P9vdnkx-Dw-GA6GR8OrOAVG6jWKmgUY6LWonZaE1JbIllDKiFVWwFYxlVteWtBAFSVaiTXgqjGqqZ2fB19X2qvFvXcNbaETNCZq-TnkO5MBG_eToK_ML_ijam4pJXmRbD1JEjxeuFyb-Y-W9d1EFxcZMNGVBOtOKUF_foOvYyLFMp2hZIjxYUmslDbS8qmmHNy7UsYSszfukypy_yrq7BfXqd_IZ_LKcDOErj1nbv7v8mMT2ZL5R-2Op4u</recordid><startdate>202012</startdate><enddate>202012</enddate><creator>Navarro‐Millán, Iris</creator><creator>Sattui, Sebastian E.</creator><creator>Lakhanpal, Amit</creator><creator>Zisa, Diane</creator><creator>Siegel, Caroline H.</creator><creator>Crow, Mary K.</creator><general>Wiley Subscription Services, Inc</general><general>John Wiley and Sons Inc</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QL</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>7U7</scope><scope>C1K</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-3945-6828</orcidid><orcidid>https://orcid.org/0000-0002-9540-6614</orcidid><orcidid>https://orcid.org/0000-0001-6057-0070</orcidid><orcidid>https://orcid.org/0000-0002-7881-2020</orcidid></search><sort><creationdate>202012</creationdate><title>Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series</title><author>Navarro‐Millán, Iris ; Sattui, Sebastian E. ; Lakhanpal, Amit ; Zisa, Diane ; Siegel, Caroline H. ; Crow, Mary K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c5372-8fc8ad8225b95be9900bc062d07568f7aac238bc3fca5aa778d639508dc8dbe3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Antirheumatic Agents - therapeutic use</topic><topic>Bacterial diseases</topic><topic>Brief Report</topic><topic>Coronaviridae</topic><topic>Coronaviruses</topic><topic>COVID-19</topic><topic>COVID-19 - drug therapy</topic><topic>COVID-19 - therapy</topic><topic>Cytokine Release Syndrome - drug therapy</topic><topic>Cytokine Release Syndrome - therapy</topic><topic>Cytokine storm</topic><topic>Cytokines</topic><topic>Failure</topic><topic>Female</topic><topic>Ferritin</topic><topic>Fever</topic><topic>Health services</topic><topic>Humans</topic><topic>Immunosuppressive agents</topic><topic>Interleukin 1 receptor antagonist</topic><topic>Interleukin 1 Receptor Antagonist Protein - therapeutic use</topic><topic>Male</topic><topic>Mechanical ventilation</topic><topic>Medical materials</topic><topic>Middle Aged</topic><topic>Oxygen</topic><topic>Patients</topic><topic>Respiration, Artificial</topic><topic>Respiratory diseases</topic><topic>Respiratory failure</topic><topic>Respiratory Insufficiency - drug therapy</topic><topic>Respiratory Insufficiency - therapy</topic><topic>Retrospective Studies</topic><topic>Severe acute respiratory syndrome</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Signs and symptoms</topic><topic>Treatment Outcome</topic><topic>Tubes</topic><topic>Ventilation</topic><topic>Viral diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Navarro‐Millán, Iris</creatorcontrib><creatorcontrib>Sattui, Sebastian E.</creatorcontrib><creatorcontrib>Lakhanpal, Amit</creatorcontrib><creatorcontrib>Zisa, Diane</creatorcontrib><creatorcontrib>Siegel, Caroline H.</creatorcontrib><creatorcontrib>Crow, Mary K.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Navarro‐Millán, Iris</au><au>Sattui, Sebastian E.</au><au>Lakhanpal, Amit</au><au>Zisa, Diane</au><au>Siegel, Caroline H.</au><au>Crow, Mary K.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series</atitle><jtitle>Arthritis & rheumatology (Hoboken, N.J.)</jtitle><addtitle>Arthritis Rheumatol</addtitle><date>2020-12</date><risdate>2020</risdate><volume>72</volume><issue>12</issue><spage>1990</spage><epage>1997</epage><pages>1990-1997</pages><issn>2326-5191</issn><eissn>2326-5205</eissn><abstract>Objective
To report the clinical experience with anakinra in preventing mechanical ventilation in patients with coronavirus disease 2019 (COVID‐19), symptoms of cytokine storm syndrome, and acute hypoxemic respiratory failure.
Methods
To be included in this retrospective case series, patients must have had severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2), fever, ferritin levels >1,000 ng/ml with 1 additional laboratory marker of hyperinflammation, and acute hypoxemic respiratory failure. Acute hypoxemic respiratory failure was defined as requiring 15 liters of supplemental oxygen via a nonrebreather mask combined with 6‐liter nasal cannula or use of ≥95% oxygen by high‐flow nasal cannula. We excluded patients in whom there was suspicion of bacterial infection or who were receiving immunosuppressants. Subcutaneous anakinra was initiated at 100 mg every 6 hours and gradually tapered off completely. The primary outcome was the prevention of mechanical ventilation.
Results
Of the 14 patients who met the criteria, 11 patients received anakinra for a maximum of 19 days. Seven of the patients who started anakinra treatment ≤36 hours after onset of acute hypoxemic respiratory failure did not require mechanical ventilation, and all were discharged home. Four patients who started anakinra ≥4 days after onset of acute hypoxemic respiratory failure required mechanical ventilation. Of those, 3 patients were extubated (2 discharged home and 1 remained hospitalized), and 1 died. All 3 patients who met the criteria but did not receive anakinra required mechanical ventilation. Two patients were extubated (1 discharged home and 1 remained hospitalized), and 1 remained on mechanical ventilation.
Conclusion
Our data suggest that anakinra could be beneficial in treating COVID‐19 patients with evidence of cytokine storm syndrome when initiated early after onset of acute hypoxemic respiratory failure. Our patient selection and treatment approach should be considered for investigation in a clinical trial to determine the safety and efficacy of anakinra in treating patients with COVID‐19 and symptoms of cytokine storm syndrome.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>32602262</pmid><doi>10.1002/art.41422</doi><tpages>8</tpages><orcidid>https://orcid.org/0000-0002-3945-6828</orcidid><orcidid>https://orcid.org/0000-0002-9540-6614</orcidid><orcidid>https://orcid.org/0000-0001-6057-0070</orcidid><orcidid>https://orcid.org/0000-0002-7881-2020</orcidid><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 2326-5191 |
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| issn | 2326-5191 2326-5205 |
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| source | MEDLINE; Access via Wiley Online Library; Alma/SFX Local Collection |
| subjects | Aged Aged, 80 and over Antirheumatic Agents - therapeutic use Bacterial diseases Brief Report Coronaviridae Coronaviruses COVID-19 COVID-19 - drug therapy COVID-19 - therapy Cytokine Release Syndrome - drug therapy Cytokine Release Syndrome - therapy Cytokine storm Cytokines Failure Female Ferritin Fever Health services Humans Immunosuppressive agents Interleukin 1 receptor antagonist Interleukin 1 Receptor Antagonist Protein - therapeutic use Male Mechanical ventilation Medical materials Middle Aged Oxygen Patients Respiration, Artificial Respiratory diseases Respiratory failure Respiratory Insufficiency - drug therapy Respiratory Insufficiency - therapy Retrospective Studies Severe acute respiratory syndrome Severe acute respiratory syndrome coronavirus 2 Signs and symptoms Treatment Outcome Tubes Ventilation Viral diseases |
| title | Use of Anakinra to Prevent Mechanical Ventilation in Severe COVID‐19: A Case Series |
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