This patient is experiencing Grade 4 Cytokine reaction – CRITICAL STATE
Arrange for critical care in ICU and discuss Tocilizumab with Pharmacist
Monitor vital signs and check for signs of neurotoxicity frequently
If hypotensive, ensure hemodynamic stability with IV fluids or vasopressors
Provide O2 support with CPAP, BIPAP or mechanical ventilation.
Administer Tocilizumab
Look for signs of other organ toxicities along with CRS triads such as bleeding, decreased urine output or tachycardia.
If no resolution in 12-18 hours, consider Corticosteroid (methylprednisolone)
If no resolution, consider 2nd dose of Tocilizumab
If no resolution in 24 hours, consider 3rd dose of Tocilizumab or another anti-T-cell therapy such as Cyclophosphamide
(Lee et al., 2019; Neelapu et al., 2018; Novartis Pharmaceuticals Canada Inc., 2018)