Our faculty member and researcher José Luis Estela-Zape, in his line of research in clinical physiology and pathophysiology, has published in the Revista Médica de Rosario (Argentina) his research titled «Unusual Recovery of an Older Adult with Severe COVID-19.» This study addresses the clinical case of a 75-year-old patient with multiple comorbidities, who overcame a critical phase of the disease, marked by severe pneumonia due to SARS-CoV-2, refractory hypoxemia, and septic shock. The experience highlights the importance of multidisciplinary therapeutic strategies based on pathophysiology to achieve recovery in high-risk contexts.

During the pandemic, COVID-19 was the leading cause of mortality among older adults, responsible for 80% of deaths in this age group between 2020 and 2021. Immunosenescence and underlying conditions limit the immune response, exacerbating the SARS-CoV-2 infection. In this case, cellular aging and comorbidities favored the expression of ACE-II receptors in alveolar cells, facilitating viral entry and triggering a dysregulated inflammatory response. This response is characterized by the overproduction of pro-inflammatory cytokines and chemokines (IL-6, IL-8, NF-κB, TNF-α, and CCL2), which activate T lymphocytes and macrophages, causing extensive tissue damage, systemic inflammation, and endothelial dysfunction. Hyperinflammation contributed to thrombus formation, disseminated intravascular coagulation, and pulmonary thromboembolism, worsening severe hypoxemia and acute respiratory distress syndrome (ARDS).

The therapeutic approach included pronation cycles and lung-protective strategies to optimize oxygenation by redistributing blood flow and reducing the pulmonary dead space generated by ARDS and thrombi. The administration of hydrocortisone and vasopressor support helped attenuate the dysregulated inflammatory response and improve hemodynamic stability. Additionally, the use of anticoagulants facilitated vasodilation and improved pulmonary ventilation and perfusion. Broad-spectrum antibiotic therapy addressed secondary infections, reducing the pathogen load and inflammatory response by inhibiting cell wall synthesis and disrupting the cell membrane.

The case analysis underscores the importance of an individualized approach based on pathophysiological mechanisms and supported by scientific evidence to improve the survival of older adults with severe COVID-19. The combination of strategies that optimize ventilation, control inflammation, and prevent thrombotic complications was crucial for the patient’s recovery. This experience provides important lessons for the comprehensive management of COVID-19 in vulnerable populations, highlighting the need to personalize interventions to improve clinical outcomes in intensive care.

Available at: https://revistamedicaderosario.org/index.php/rm/article/view/255