There are no absolute contraindications for the treatment

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Initial routine administration of methylprednisolone at a dose of 0.75~1.5mg/kg IV once a day (almost 40mg once or twice a day) is recommended. However, methylprednisolone at a dose of 40mg every 12h can be considered for patients with decreasing body temperature or for patients with significantly elevated cytokines with routine steroid doses. Even methylprednisolone at a dose of 40mg-80mg every 2h can be considered in critical cases. Closely monitor body temperature, blood oxygen saturation, blood work, C-reactive protein, cytokines, biochemical profile and lung CT every 2-3 days during treatment as needed. The dosage of methylprednisolone should be halved every 3-5 days if the patients' health condition improves, body temperature normalizes or the involved lesions on CT are significantly absorbed. Oral methylprednisolone (Medrol) is recommended to be given once daily, with the intravenous dose tapered to 20 mg daily. The course of corticosteroid treatment is not defined; some experts suggest stopping corticosteroid treatment when patients are nearly recovered.

1.3 Special attention during treatment

screening for tuberculosis with T-spot assay, HBV and HCV with antibody assay should be performed before initiating corticosteroid therapy;
proton pump inhibitors may be considered to prevent complications;
Blood glucose levels must be monitored. If necessary, elevated blood glucose levels should be treated with insulin;
low serum potassium levels should be corrected;
liver function should be closely monitored;
Traditional Chinese herbal medicine may be considered for patients who sweat;
Sedative-hypnotics may be temporarily prescribed to patients with sleep disorders.
2 Treatment with artificial liver support to suppress the cytokine cascade

The artificial liver support system (ALSS) can perform plasma exchange, adsorption, perfusion and filtration of inflammatory mediators such as endotoxins and harmful metabolic substances of small or israel number data medium molecular weight. It can also provide serum albumin, coagulation factors, balanced fluid volume, electrolytes and acid-base balance, and exhibit anti-cytokine storm, shock, pneumonia, etc. At the same time, it can also help improve the functions of many organs including the liver and kidney. Thus, it can improve the success of treatment and reduce the mortality of severe patients.

2.1 Indications for use of ALSS

serum inflammatory indicator (eg, IL-6) levels rise to ≥5 elbow joints, or the rate of increase is ≥1 time per day;
involved area on lung CT or X-ray images ≥10% progression per day;
Artificial liver support system is necessary for the treatment of underlying diseases. Patient meetings 1 + 2, or patient meetings 3.
2.2 Contraindications

of seriously ill patients. However, ALSS should be avoided in the following situations:

Severe bleeding or disseminated intravascular coagulation;
Those who have a severe allergy to blood components or drugs used in the treatment process, such as plasma, heparin and protamine;
Acute cerebrovascular disease or severe traumatic brain injury;
Chronic heart failure, cardiac functional classification ≥ grade III;
Uncontrolled hypotension and shock;
Severe arrhythmia.