The use of an Inhaled Surfactant in Patients With Severe and Extremely Severe new Coronavirus Infection COVID-19 With Concomitant Cardiovascular Pathology.

Aim      To study the effectiveness of nebulized surfactant therapy as a part of a multimodality treatment of severe and extremely severe COVID-19 viral pneumonia with concomitant cardiovascular diseases (CVDs).Material and methods  This retrospective controlled study analyzed a multimodality treatment of 38 patients with severe and extremely severe COVID-19 viral pneumonia and concomitant CVDs who were administered nebulized surfactant for correction of acute respiratory distress syndrome (ARDS). The control group consisted of 105 patients with severe and extremely severe novel coronavirus infection with concomitant CVDs who were not administered surfactant as a part of the multimodality therapy.Results Administration of nebulized surfactant as a part of the multimodality treatment in patients with COVID-19 allowed alleviating the severity of respiratory insufficiency (р<0.001), which decreased the death rate of patients with severe and extremely severe COVID-19 and undoubtedly demonstrated the effectiveness of this medicine. The timely multimodality therapy, including nebulized surfactant, improves the course of the disease. Thus, the absence of a possibility for administering nebulized surfactant for more than 4 days was associated with fatal outcomes (р=0.045).Conclusion      Administration of nebulized surfactant as a part of the multimodality treatment of severe and extremely severe COVID-19 and concomitant CVDs increases the survival (р<0.001) and reduces the mortality by 46 %. The risk factors of an unfavorable outcome of this disease include an age older than 65 (р=0.020), a positive polymerase chain reaction test (р=0.037), a ferritin concentration at baseline >600 mg /ml (р<0.001), and a surfactant treatment duration < 4 days (р=0.045). Further study of the efficacy of nebulized surfactants as a part of the multimodality therapy is required and should include randomized clinical trials with a large number of patients and the development of distinct criteria for the treatment of ARDS.

Treatment of myocarditis in COVID-19 patients

Objective. To describe a few cases of COVID-19-associated myocardial damage, to analyze its pathogenesis, approaches to diagnosis and treatment. Material and methods. All our patients with myocarditis and a new coronavirus infection had life-threatening heart rhythm disturbances, including ventricular fibrillation with clinical death and subsequent intensive care, syncope following bradyarrhythmia in 2 cases, as well as atrial fibrillation with thrombosis of the right atrial appendage. Results. In all cases, specialized medical care saved patient lives, and appropriate therapy restored sinus rhythm and compensated heart failure. Heart rhythm disturbances in our patients were transient and regressed within 3 months. Specific drug therapy was carried out according to generally accepted approaches, and only 1 patient with sudden ventricular fibrillation and subsequent successful intensive care required implantable cardioverter-defibrillator. Conclusion. Myocarditis following a new coronavirus infection may be accompanied by life-threatening heart rhythm disturbances with possible fatal outcomes in the absence of appropriate medical care. The features of myocarditis associated with SARS-CoV-2 infection may be a delayed nature of clinical manifestations or lightning-fast course with acute heart failure, arrhythmias, as well as transient damage with fast recovery throughout the treatment. Follow-up of patients with previous inflammatory myocardial lesions, analysis of other cases of COVID-19-associated myocarditis and a large sample are necessary for subsequent analysis. © 2022, Media Sphera Publishing Group. All rights reserved.