Compassionate Use of Remdesivir for Patients with Severe Covid-19.

BACKGROUND: Remdesivir, a nucleotide analogue prodrug that inhibits viral RNA polymerases, has shown in vitro activity against SARS-CoV-2. METHODS: We provided remdesivir on a compassionate-use basis to patients hospitalized with Covid-19, the illness caused by infection with SARS-CoV-2. Patients were those with confirmed SARS-CoV-2 infection who had an oxygen saturation of 94% or less while they were breathing ambient air or who were receiving oxygen support. Patients received a 10-day course of remdesivir, consisting of 200 mg administered intravenously on day 1, followed by 100 mg daily for the remaining 9 days of treatment. This report is based on data from patients who received remdesivir during the period from January 25, 2020, through March 7, 2020, and have clinical data for at least 1 subsequent day. RESULTS: Of the 61 patients who received at least one dose of remdesivir, data from 8 could not be analyzed (including 7 patients with no post-treatment data and 1 with a dosing error). Of the 53 patients whose data were analyzed, 22 were in the United States, 22 in Europe or Canada, and 9 in Japan. At baseline, 30 patients (57%) were receiving mechanical ventilation and 4 (8%) were receiving extracorporeal membrane oxygenation. During a median follow-up of 18 days, 36 patients (68%) had an improvement in oxygen-support class, including 17 of 30 patients (57%) receiving mechanical ventilation who were extubated. A total of 25 patients (47%) were discharged, and 7 patients (13%) died; mortality was 18% (6 of 34) among patients receiving invasive ventilation and 5% (1 of 19) among those not receiving invasive ventilation. CONCLUSIONS: In this cohort of patients hospitalized for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomized, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.).

Effects of Length of Vasopressors Infusion on Mortality.

Background There has been a myriad of studies into the physiology of vasopressors and the survival benefit of vasopressor initiation in cases of septic shock. The aim of the Effects of Length of Vasopressors Infusion on Mortality (ELVI-Mortality) study is to observe a relationship between the length of vasopressor infusion and mortality in the intensive care unit. Methods This was a single-center, retrospective, matched-cohort study that collected data from Arrowhead Regional Medical Center's electronic medical records (EMR; MediTech, MA, US) using International Classification of Diseases, Tenth Revision (ICD-10) coding and a chart reviewing the past five years. Patients were on norepinephrine, phenylephrine, or epinephrine. Two patient groups were compared. The first group encompassed those with vasopressor infusion less than 48 hours in duration, whereas the second group included those with vasopressor infusion greater than 48 hours. Results A total of 193 patients were diagnosed as having septic shock. Participant data were obtained for 163 patients (84.4%). Of the 106 patients who had a vasopressor duration of less than 48 hours, 32 patients (30.2%) expired. Of the 57 patients that had more than 48 hours of vasopressor infusion, 18 patients (31.6%) expired. Conclusions There was no statistically significant increase in mortality in patients with vasopressor infusion greater than 48 hours as compared to less than 48 hours.