Effectiveness of Vaccination and Non-Invasive Ventilation in a Critical Kidney Transplant Patient Positive for COVID-19: a Case Report

Abstract

BACKGROUND: During the COVID-19 pandemic, the immunocompromised population was at high risk of severe SARS-CoV-2 infection and intensive care unit admission. When writing this case report, there was a modest amount of evidence in the literature regarding the effectiveness of COVID-19 vaccination, non-invasive ventilation, and pronation in these individuals. The primary nursing objective of this study is to evaluate the effectiveness of nursing interventions (vaccination, non-invasive ventilation, pronation) on a critical patient, particularly a kidney transplant recipient, with COVID-19.

CASE PRESENTATION: This case report examines the clinical course of a 60-year-old male patient, a kidney transplant recipient with residual renal failure, receiving immunosuppressive therapy, and vaccinated with two doses for SARS-CoV-2, who was admitted to the intensive care unit for respiratory failure due to COVID-19 pneumonia. In the intensive care unit (ICU), he underwent 4 cycles of pronation with non-invasive ventilation (NIV) using a full-face mask before the decision for intubation was made.

CONCLUSIONS: Solid organ transplant recipients develop an immune response to the COVID-19 vaccine significantly lower than that of healthy individuals or the general population. Immunosuppressive therapy appears to be the most important risk factor associated with the failure of seroconversion, but other risk factors are also present. Regarding the suspension of immunosuppressive drugs, it was found that in asymptomatic or mildly symptomatic patients, a "watchful waiting" approach is mainly used. Additional aspects analyzed included the choice between different modes of non-invasive ventilation administration, the types of patients for whom non-invasive ventilation and pronation are recommended, and the latter's impact on respiratory exchanges and their duration.