CHEST Guidelines-First,-Do-No-Harm

First,-Do-No-Harm_chest

Pdf Summary

In a letter to the editor, Dr. Fiore Mastroianni expresses concern over the use of tocilizumab, an IL-6 inhibitor, for treating severe COVID-19 cases based on a report by Radbel et al. published in CHEST. Mastroianni highlights that the rationale for using IL-6 inhibitors arises from the hypothesis that a "hyperinflammatory state" drives severe COVID-19 morbidity; however, evidence to support this remains inconclusive. C-reactive protein levels in COVID-19 are not significantly different from those in other forms of pneumonia or ARDS. While reducing IL-6 has been suggested to potentially yield beneficial effects due to its association with poor outcomes in various diseases, IL-6 may, in fact, have a protective role in viral infections, which complicates this hypothesis. Mastroianni advocates for the cautious, controlled use of tocilizumab, ideally in clinical trials, cautioning against its uncontrolled off-label use due to the uncertainty surrounding its effects.<br /><br />Further, Mastroianni emphasizes the danger of relying on preprint manuscripts, press releases, and non-peer-reviewed studies, stressing the need for well-conducted, controlled trials to provide actionable and reliable treatment information during the COVID-19 pandemic. The letter advocates for prioritizing non-harmful practices over the urge to intervene aggressively without solid evidence. The letter commends Radbel et al. for highlighting these concerns.<br /><br />Additionally, there is a reference to the study on postextubation dysphagia in ICU patients, suggesting that research into this complication should consider competing risks, such as death, which affect the observation and analysis of dysphagia development. The letter suggests that deaths prior to extubation might skew results, indicating the need for careful statistical modeling to account for these biases.

Keywords

tocilizumab

IL-6 inhibitor

COVID-19

hyperinflammatory state

C-reactive protein

clinical trials

preprint manuscripts

postextubation dysphagia

ICU patients

statistical modeling