On February 25 th 2020, we admitted the first patient with severe COVID-19 pneumonia to our ICU. The assessment of serum levels of proinflammatory biomarkers and cytokines has become common in clinical practice for early recognizing COVID-19 patients at risk for clinical worsening and who could benefit by the use of specific immunosuppressive agents. To reduce the burden of this hyperinflammatory state many authors postulated the use of drugs with selective ( e.g., anti-interleukin 1 and 6) and unselective ( e.g., steroids, immunoglobulins) block of inflammatory mediators. Uncontrolled immune response characterized by systemic hyper-inflammation with an abnormal increase of circulating cytokines and chemokines (the so-called cytokine storm) is common in critically ill COVID-19 patients and seems to have a pivotal role in lung tissue damage, increase in vascular permeability and clots formation. In the last weeks, the scientific community provided a tremendous improvement in the knowledge of mechanisms involved in COVID-19 pathobiology. Therefore, along with the maintenance of vital functions by supportive treatments, effective therapies in COVID-19 are urgently needed and several trials are underway worldwide for evaluating the effects of new and old antivirals agents, hydroxychloroquine, convalescent plasma, specific immunosuppressive agents and others. Unfortunately, so far there are no validated therapies to prevent or treat the severe acute respiratory distress syndrome (ARDS) caused by this novel virus and, thus, the case-fatality rate in patients admitted to ICU is extremely high, ranging from 30 to 80%. Since February 20 th, 2020 Italy has been overwhelmed by SARS-CoV-2 virus outbreak and several patients with interstitial pneumonia and respiratory failure requiring mechanical ventilation were admitted to our intensive care unit (ICU). Virology and Molecular Microbiology Unit: Monica Pecorari, William Gennari, Antonella Grottola, Giulia Fregni Serpini. Respiratory Diseases Unit: Enrico Clini, Roberto Tonelli, Riccardo Fantini, Ivana Castaniere, Luca Tabbi, Giulia Bruzzi, Chiara Nani, Fabiana Trentacosti, Pierluigi Donatelli, Maria Rosaria Pellegrino, Linda Manicardi, Antonio Moretti, Morgana Vermi, Caterina Cerbone. Infectious Disease Unit: Cristina Mussini, Giovanni Guaraldi, Marianna Meschiari, Alessandro Cozzi-Lepri, Jovana Milic, Marianna Menozzi, Erica Franceschini, Gianluca Cuomo, Gabriella Orlando, Vanni Borghi, Antonella Santoro, Margherita Di Gaetano, Cinzia Puzzolante, Federica Carli, Andrea Bedini, Luca Corradi. Immuno-Lab: Andrea Cossarizza, Caterina Bellinazzi, Rebecca Borella, Sara De Biasi, Anna De Gaetano, Lucia Fidanza, Lara Gibellini, Anna Iannone, Domenico Lo Tartaro, Marco Mattioli, Milena Nasi, Annamaria Paolini, Marcello Pinti. Intensive Care Unit: Massimo Girardis, Alberto Andreotti, Emanuela Biagioni, Filippo Bondi, Stefano Busani, Giovanni Chierego, Marzia Scotti, Lucia Serio, Annamaria Ghirardini, Marco Sita, Stefano De Julis, Lara Donno, Lorenzo DallAra, Fabrizio Di Salvo, Carlotta Farinelli, Laura Rinaldi, Ilaria Cavazzuti, Andrea Ghidoni, Antonio Buono, Elena Ferrari, Daniela Iseppi, Anna Maria Ardito, Irene Coloretti, Sophie Venturelli, Elena Munari, Martina Tosi, Erika Roat, Ilenia Gatto, Marco Sarti.

Distressed fx v2