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Sigman S.A. et al.: A 57-year-old African American man with severe COVID-19 pneumonia... © Am J Case Rep, 2020; 21: e926779 Table 2. Evaluation criteria before and after photobiomodulation therapy in a COVID-19 patient. Parameters Before treatment After treatment Normal range or evaluation criteria PSI Class V (142) Class II (67) Risk Class (Points): Disposition Class I (<50): Outpatient Class II (51–70): Outpatient Class III (71–90): Outpatient/brief Inpatient Class IV (91–130): Inpatient Class V (>130): Inpatient SMART-COP 5 2 0 points: Very low risk of needing IRVS 1 point: Low risk (1 in 20) of needing IRVS 2 points: Moderate risk (1 in 10) of needing IRVS 3 points: High risk (1 in 6) of needing IRVS 34 points: High risk (1 in 3) of needing IRVS; Consider ICU admission Brescia-COVID 4 0 0 – monitor 1 – add O2 and monitor 2 – CXR, ABG, O2 therapy, monitor >2 – HFNC and reassess. If still >2, intubate. CAP total 36.68 82.82 Calculated based on (CAP) score questionnaire: 75–100% CAP respiratory 67.52 87.17 75–100% CAP well-being 0.0 73.07 75–100% RALE 8 5 Lungs score dependent on extent of involvement based on consolidation or ground-glass opacities for each lung, total score is the sum of the score of the lungs: 0 – no involvement; 1 – <25% of lung involved; 2 – 25–50% of lung involved; 3 – 50–75% of lung involved; 4 – >75% of lung involved. WBC 10.7 6.5 4.5–11 CRP 15.1 1.23 3 mg/mL O2 Requirement 2–3 L/min 1 L/min 0 L/min SpO2 93–94% 100% 394% PSI – Pneumonia Severity Index; SMART-COP – Systolic blood pressure, Multilobar infiltrates, Albumin, Respiratory rate, Tachycardia, Confusion, Oxygen, and pH; CAP – Community-Acquired Pneumonia; RALE – Radiographic Assessment of Lung Edema; SpO2 – Oxygen saturation; WBC – White Blood Cells; CRP – C-Reactive Protein; IRVS – Intensive Respiratory or Vasopressor Support; CXR – Chest x-ray; ABG – Arterial Blood Gas; HFNC – High-Flow Nasal Cannula. The therapeutic effects of PBMT on pneumonia are thought to occur via local and systemic effects that reduce inflamma- tory cytokines, cellular infiltrates, edema and fibrosis, and in- crease anti-inflammatory cytokines and processes, and promote healing. Local PBMT affects the entire body when photoprod- ucts are distributed via the vasculature to reach distant tar- gets. Activated photoproducts lead to alleviation of inflam- mation and immunomodulatory effects, and stimulate wound healing and tissue regeneration [4]. Animal studies illustrate the potency of PBMT. Transcutaneous PBMT in murine models for pulmonary fibrosis and ARDS significantly reduced pro-inflammatory cytokines, inflammatory cells, and collagen fiber deposition in lung pa- renchyma [14–18]. In contrast, the anti-inflammatory cytokine interleukin-10, serum monocytes, and lung macrophages were significantly increased following PBMT [15,17]. The molecular basis of MLS laser anti-inflammatory effects has been demon- strated in murine and in vitro models [31–33]. In particular, it has been shown to inhibit inflammasome activation, inhibit- ing interleukin-1b and interleukin-18, whose downstream sig- naling induces the production of interleukin-6, interleukin-8, tumor necrosis factor a (TNF-a), and interferon-g, which are im- plicated in ARDS caused by COVID-19 infection [14–18,31–33]. This work is licensed under Creative Common Attribution- NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0) 5 Indexed in: [PMC] [PubMed] [Emerging Sources Citation Index (ESCI)] [Web of Science by Clarivate] APPROVED GALLEY PROOFPDF Image | A COVID-19 Pneumonia Responded to Photobiomodulation Therapy
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