Critical Care - Theses
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ItemThe cytokine response to COVID-19 and the effects of immunomodulation in the intensive care unit( 2022)Critically ill patients are at risk of immune dysregulation and organ dysfunction. New therapeutic techniques to treat various critical illness states are constantly emerging. One technique which has shown therapeutic promise in severe COVID-19 is immunomodulation. However, the broad immunological effects of these therapeutics in intensive care unit (ICU) patients, and whether such strategies could be applied to other critical illness states, such as trauma, remain poorly understood. This was a single-centre prospective observational case-control study of COVID-19 and trauma patients that were admitted to the Royal Melbourne Hospital ICU. Blood samples from patients were taken on days 1, 3, and 5 post-ICU admission and on a single occasion for healthy volunteers. Plasma cytokine concentrations were measured using a cytokine bead array. A total of 26 COVID-19, 20 trauma and 18 healthy participants were enrolled. We quantified concentrations of 34 unique soluble proteins in the plasma. Molecules such as IL-8, MPO, MMP-9, were higher in the COVID-19 cohort than trauma over the duration of ICU stay. IL-6 and myoglobin were highest in the trauma group from day 1, and the COVID-19 group increased to similar levels by day 5. COVID-19 patients treated with Baricitinib displayed lower levels of IL-6 and IL-8. Although the human cytokine response to these two critical illness syndromes was highly variable, key differences were identified between trauma and COVID-19 patients that indicate distinct, individual responses to generalised severe inflammation and treatment with immunomodulators, highlighting the importance of specifying critical care strategies to the patient’s immune status.