Since the late 2019, SARS-CoV2 has spread worldwide, leading WHO to declare a pandemic state. Italy resulted deeply affected by the infection, especially the North. Although there is no proven specific treatment for the infection and for the pulmonary disease, several molecules have been tested always comparing efficacy and collateral effects. Oxygen support plays a key role in the management of this type of patients along with the collaboration with intensive care specialists. This case regards a COVID-19 patient whose clinical parameters deteriorated few days after admission and who had been treated with both Tocilizumab and High Flow Nasal Oxygenation. A 55 yo caucasian female was admitted to ED because of fever and dyspnea. Her chest X-ray showed bilateral ground glass areas and blood examinations revealed elevated inflammatory markers along with lymphopenia. RT-PCR for SARS-CoV2 resulted positive and the patient was transferred to our Unit. We started administration of antiviral therapy with Lopinavir/ritonavir, hydroxychloroquine plus azithromycin, along with antibiotic therapy and anticoagulant treatment. Despite the therapy, her clinical conditions started deteriorating together with chest X-ray findings and arterial blood gas parameters. Inflammatory markers were elevated too. We started High Flow Nasal Cannula Oxygenation (HFNC) along with Tocilizumab administration. In two days, respiratory frequency and arterial blood gas data were ameliorated and chest X-ray improved too. In six days, she started waning HFNC and, after ten days, she stopped. Due to the important clinical and radiological amelioration along with two negative results on RT-PCR for SARSCoV2, the patient was discharged. Conclusions: It is indisputable that we need more data and guidelines about COVID19 therapies that lead us through the correct clinical behavior to guarantee the best treatment for these patients.

In late 2019, pneumonia of unknown origin was reported in Wuhan, China. The causative pathogen has been soon identified as a novel beta-coronavirus, subsequently named Severe Acute Respiratory Syndrome Coronavirus 2 (SARSCoV2). Since then, there has been a rapid spread of the virus worldwide, leading the World Health Organization to declare SARS-CoV2 outbreak a global pandemic on March 11, 2020. Most infected individuals who develop disease from SARSCoV2 infection (COVID-19) exhibit a mild-to-moderate illness (80%); however, 14% have serious disease and in 5% it evolves in a severe Acute Respiratory Distress Syndrome (ARDS) requiring intensive care support. Up to the 8th of June 2020, more than 7 million cases of SARSCoV2 infections have been reported and 406.353 people died worldwide. So far, a total of 234.998 cases have been reported in Italy, 33.899 of which have died. Two main phases of the disease have been recognized, a “viral phase” with mild-to-moderate symptoms and an “inflammatory phase”, which could induce the development of ARDS. Due to the urgency to find effective therapeutical strategies, many treatments have been investigated to identify drugs both efficacious and safe against COVID-19 main phases. Until now, there are no proven specific antiviral agents to treat COVID-19; however, several new and old molecules have been used in the context of clinical trials while waiting for solid evidences to make drugs administration safer and more precise. As regards the second phase, one of the most studied treatments is the monoclonal antibody Tocilizumab that blocks the cellular receptor of IL-6, which plays a crucial role in the development and maintenance of inflammation. Oxygen support along with Intensive care specialists’ assistance play a pivotal role in the management of severe COVID-19 cases. In that context, High Flow Nasal Oxygenation represents an essential support in the governance of these critical patients.

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• Alpine
• Associate Editor J
• journal of Clinical Trials
• clinicaltrials@eclinicalsci.com