Aim. The emerging outbreak of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to spread worldwide. Beside the prescription of some promising drugs as chloroquine, azithromycin, antivirals (lopinavir/ritonavir, darunavir/cobicistat) and immunomodulating agents (steroids, tocilizumab), in our patients with mild to moderate pneumonia due to SARS-CoV-2 we planned a randomize study to evaluate, respect the best available therapy (BAT), the use of autohemotherapy treatement with an oxygen/ozone (O3) gaseous mixture as adjuvant therapy. Design. Multicentric, randomized study. Participants. Clinical presentations are based upon clinical phenotypes identified by the Italian Society of Emergency and Urgency Medicine (SIMEU - Società Italiana di Medicina di Emergenza-Urgenza) and patients that meet criteria of phenotypes 2 to 4 were treat with best available therapy (BAT), and randomized to receive or not O3-autohemotherapy. Main outcome measures. The end-point were the time of respiratory improvement and earlier weaning from oxygen support: these parameters were included in the SIMEU clinical phenotypes classification.
Recruitment Details.
The investigator enrolled, in the study, subjects with COVID-19 modest to moderate
respiratory insufficiency (SIMEU clinical phenotypes 2-4) thus cared in an infectious disease
ward.
To note that The Italian Society of Emergency and Urgency Medicine (SIMEU - Società Italiana
di Medicina di Emergenza-Urgenza) suggest to classified the COVID-19 patients in 5 clinical
phenotypes:
- Phenotype 1: subjects with fever and without respiratory failure (normal Arterial Blood
Gas analysis - ABG -, six-minute walking test - 6mWT - and Chest XR). These patients
usually can manage at home maintaining quarantine period.
- Phenotype 2: subjects with fever but with ABG and/or Chest XR indicative of modest
respiratory insufficiency (PO2> 60 mmHg in ambient air) and / or pulmonary consolidation
area. These patients need to be hospitalized because they can get quickly worse.
- Phenotype 3: subjects with fever associate to moderate-severe respiratory insufficiency
(at triage PO2< 60 mmHg in ambient air) and /or bilateral pulmonary consolidation area
at Chest XR. These patients need to be treated with high flow oxygen therapy.
- Phenotype 4: subjects with respiratory failure with suspected ARDS (Adult Respiratory
Distress Syndrome) or complicated pneumonia. These patients require hospitalization in
sub-intensive care unit.
- Phenotype 5: subject with ARDS at the beginning. These patients will require Intensive
Care Unit (ICU) admission and non-invasive positive pressure ventilation (NIPPV) or
mechanical ventilation.
Procedure: Medical Ozone procedure
The systemic ozone treatment procedure was decided by the physician on duty and started preliminarily at the patient's bed with the drawing of autologous blood and, after proper O2/O3 mixing, with its re-infusion. After junction of an adequate venous patient's way with a dedicated latex free plastic bag containing 35 ml of sodium citrate, a blood amount of 200 ml is taken. At the end, the withdrawal line was washed and the re-infusion one was filled with saline solution. The blood, without any patient disconnection, was then mixed with a gas mixture of a 200 cc composed by 96% of Oxygen and 4% of Ozone with a therapeutic O3 range of 40 μg/mL of gas per mL of blood. In order to guarantee the O2/O3 homogeneous diffusion into the blood, the bag was gently mixed for about 10 minutes, therefore the blood was re-infused into the patients. The duration of ozone treatment lasted for 3 consecutive days.
Inclusion Criteria:
- Male and no pregnant female patients 18 years of age or older were eligible if they
had a diagnostic specimen that was positive on RT-PCR, had pneumonia confirmed by
chest imaging and gave their informed consent to participate at the study
Exclusion Criteria:
- Exclusion criteria were pregnancy, G6PHD (glucose 6 phosphate dehydrogenase)
deficiency, concomitant serious disease and failure to obtain informed consent.
Dott. Amato De Monte
Udine, Italy
Investigator: Amato De Monte, MD
Carlo Tascini, MD
+39 0432 559355
c.tascini@gmail.com
Emanuela Sozio, MD
+39
emanuela.sozio@gmail.com
Amato De Monte, Study Chair
Presidio Ospedaliero Universitario "Santa Maria della Misericordia", Udine - Italy