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Aim. To assess the effectiveness of medical rehabilitation after pneumonia associated with the novel coronavirus infection (COVID-19), based on the study of functional capacity of the cardiovascular system and the external respiratory system. Methods. The study included 70 patients who had COVID-19 pneumonia and underwent a medical rehabilitation program from September to December 2020. Before being included in the rehabilitation program, all patients underwent pulmonary function tests (PFT), including an assessment of the lungs diffusion capacity, cardiopulmonary exercise testing, multispiral computed tomography (MSCT) of the chest, echocardiography, an evaluation of the quality of life according to the SF-36 questionnaire and the severity of shortness of breath on the mMRC scale. The effectiveness of rehabilitation was evaluated against the changes in PFT parameters, exercise tolerance, and quality of life. Results. At the enrollment, 46% of patients retained lung tissue lesions shown by MSCT and accompanied by a decrease in the lung diffusion capacity (67 (55 – 79%) of predicted value), dyspnea of 1.6 (1.0 – 3.0) points according to mMRC scale, moderate level of exercise tolerance and quality of life. Complex cardiopulmonary rehabilitation for 12 – 14 days in a specialized hospital led to a significant improvement in the parameters of pulmonary gas exchange and ventilation, peak oxygen consumption, and an increase in the reserve capacity of the cardiorespiratory system. The factors limiting the improvement of pulmonary gas exchange were the older age of the patients and the increased pressure in the pulmonary artery system. The positive influence of rehabilitation on both the physical and psycho-emotional components of the quality of life was noted. Conclusion. Complex cardiopulmonary rehabilitation with the assessment of changes in the oxygen metabolism parameters and functional capacity of the cardiovascular and respiratory systems has shown to be safe and highly effective in the studied group of patients who have had COVID-19 pneumonia. © 2021 Medical Education. All rights reserved.
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OBJECTIVE: To study the features of the psychoemotional status in patients with chronic thromboembolic pulmonary hypertension in the long term after pulmonary thromboendarterectomy (PTE) during the COVID-19 pandemic and to identify factors affecting the development of clinically pronounced anxiety and depressive disorders. MATERIAL AND METHODS: Psychoemotional status was analyzed in 151 patients in the long term after PTE using the Generalized Anxiety Disorder (GAD) Assessment (GAD-7) and the Beck Depression Inventory. The number of patients who underwent COVID-19 was recorded and the functional status scale of the patient who underwent COVID-19 (PCFS) was evaluated. Logistic regression analysis was used to identify predictors of clinically pronounced depression and GAD in the long-term period after surgery during the COVID-19 pandemic. RESULTS: Clinically significant GAD and depression in the long-term period after PTE during the COVID-19 pandemic were observed in 11 and 17.8% of patients, respectively. Clinically pronounced depression is associated with older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status according to PCFS. The development of GAD symptoms is influenced by cardiopulmonary insufficiency in the hospital period after PTE. The combination of anxiety and depression symptoms is correlated with older age. CONCLUSION: In patients in the long term after PTE during the COVID-19 pandemic, the symptoms of GAD and depression were detected in 11 and 17.8% of cases, respectively. The complicated course of cardiac surgery has shown a negative impact on the development of GAD in the long term after surgery. The factors influencing the development of clinically pronounced depression were older age, chronic cerebral circulatory insufficiency and pronounced post COVID-19 disorders of functional status.
Subject(s)
COVID-19 , Cardiac Surgical Procedures , Hypertension, Pulmonary , Anxiety , Depression , Endarterectomy , Humans , PandemicsABSTRACT
Aim. To assess the outcomes of myocardial revascularization (MR) and identify risk factors for early postoperative complications in patients with coronary artery disease (CAD) with acute coronary syndrome (ACS) in the context of coronavirus disease 2019 (COVID-19) pandemic. Material and methods. The study included 769 patients aged 67,0±4,4 years with CAD with ACS in the period from April to October 2020. In an expedited manner, percutaneous transluminal coronary angioplasty (n=699) and on pump coronary artery bypass grafting (CABG) (n=70) were performed. All patients underwent a COVID-19 rapid tests. After MR, the following outcomes were recorded: adverse cardiovascular events and other complications;various surgical interventions;bilateral COVID-19 pneumonia;death. The follow-up period lasted 30 days. Results. During the hospitalization, COVID-19 was detected in 5,3% of patients (n=41). Among them, bilateral multisegmental pneumonia developed in 48,8%. Among infected patients, COVID-19-related mortality in the early postoperative period was 9,8%. The all-cause mortality rate was 0,7%. On pump CABG significantly increases the risk of developing COVID-19 pneumonia (odds ratio (OR), 23,2;95% confidence interval (CI) 14,2-35,4;p<0,001). After MR, COVID-19 pneumonia was associated with respiratory (OR, 7,6;95% CI, 4,3-11,5;p=0,001) and heart failure (OR, 4,2;95% CI, 2,9-8,6;p=0,001), atrial fibrillation (OR, 8,3;95% CI, 4,1-13,9;p=0,001), as well as with all-cause mortality (OR, 10,3;95% CI, 5,2-16,7;p=0,005). Recurrent transmural myocardial infarction in patients with CAD was associated with heart failure after MR (OR, 7,1;95% CI, 2,4-12,6;p=0,012). Conclusion. Conducting on pump CABG in patients with CAD with ACS is the leading trigger for developing COVID-19 pneumonia, which, during hospitalization after MR, was associated not only with respiratory complications, but also with impaired heart function, which significantly increases the death risk in this category of patients.
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Aim To present clinical observations of the novel coronavirus infection (COVID-19) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) after a surgical intervention in the form of thromobendarterectomy from pulmonary artery branches.Material and methods The Acad. E.N. Meshalkin National Medical Research Center performed 127 open surgical interventions for CTEPH in the form of thromobendarterectomy from 2016 through 2020. The present study enrolled 113 patients included into the follow-up care group and into the Center Registry who were followed up for more than 6 months after the surgery. Clinical and functional features of COVID-19 were evaluated in the studied group.Results In the follow-up care group, 5 (4.4%) postoperative CTEPH patients had COVID-19. One patient had asymptomatic disease, and others had typical clinical symptoms and bilateral polysegmental pneumonia. There were no cases requiring artificial ventilation and no lethal outcomes. All patients with COVID-19 received anticoagulants as a basis therapy for CTEPH, and two patients who had residual pulmonary arterial hypertension (PAH) additionally received a PAH-specific therapy. During the treatment of COVID-19, no adjustment of the anticoagulant or PAH-specific therapy was required.Conclusion The group of patients with CTEPH is a unique pathophysiological model for studying the effect of COVID-19 under the conditions of compromised pulmonary circulation. In the studied follow-up care group, the COVID-19 morbidity was 4.4â% without fatal outcomes. Evaluation of the role of chronic anticoagulant and PAH-specific therapy in COVID-19 postoperative patients as well as evaluation of the role of COVID-19 in CTEPH progression merit further investigation.
Subject(s)
COVID-19 , Hypertension, Pulmonary , Pulmonary Arterial Hypertension , Pulmonary Embolism , Chronic Disease , Humans , Hypertension, Pulmonary/etiology , Pulmonary Embolism/complications , SARS-CoV-2ABSTRACT
Aim. To assess the prevalence and clinical and functional features of a new coronavirus infection (COVID-19) in patients who underwent pulmonary thromboendarterectomy (PTE) using data from a single-center registry. Methods. This study included 127 patients with chronic thromboembolic pulmonary hypertension who underwent PTE from January 2016 to March 2020 and were included in a follow-up group. The follow-up after surgery was 6 or more months. The prevalence of COVID-19 and clinical and functional properties of the cardiorespiratory system were assessed in the study group. Results. The average follow-up period after PTE in the study group was 2.5 ± 0.9 years. 14 (11%) deaths not associated with COVID-19 were reported during this period. 5 cases of COVID-19 were detected among the remaining 113 patients. In one case, the infection was asymptomatic, while other patients had the typical clinical symptoms and developed bilateral polysegmental pneumonia. No patients required mechanical ventilation or died of COVID-19. All patients who underwent PTE were compliant with anticoagulation therapy and PAH-specific therapy for residual pulmonary hypertension. No adjustment of PAH-specific and anticoagulation therapy was required during COVID-19. Conclusion. The prevalence of COVID-19 in patients who underwent PTE was 4.4%, no deaths were recorded. Outpatient follow-up and timely informing of patients undergoing PTE allow keeping the COVID-19 morbidity and mortality in the studied group at the general population level. Evaluation of the impact of chronic anticoagulants and PAH-specific therapy on the outcome of COVID-19 deserves further research. © 2021 Medical Education. All rights reserved.
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In November-December 2020, the Federation of Anesthesiologists and Reanimatologists has conducted a survey of intensive care units (ICU) in 100 hospitals re-profiled for the treatment of COVID-19. There were regional (n=44), city (n=31), district (n=13), inter-district (n=8) and federal (n=4) hospitals from 27 constituent entities of the Russian Federation. Capacity of 59 hospitals was less than 300 beds, 23 hospitals — over 500 beds, 18 hospitals — 300—500 beds. The number of ICU beds exceeded 10% of repurposed beds in 35 hospitals, 5—10% of ICU beds — in 51 hospitals, less than 5% — in 14 hospitals. There were 6—12 patients per one physician in 68 ICUs, less than 6 patients — in 12 ICUs, over 12 patients — in 20 ICUs. Also, there were 3-6 patients per a nurse in 69 ICUs, less than 3 patients — in 2 ICUs, over 6 patients — in 29 ICUs. Over 70% of the repurposed beds were provided with a networked oxygen supply in 61 hospitals, 50—70% — in 25 hospitals, less than 50% — in 14 hospitals. Oxygen flow rate over 10 l/min was provided in 70 hospitals, 5—10 l/min — in 28 hospitals, less than 5 l/min — in 2 hospitals. Over 80% of ICU beds are equipped with ventilators in 78 hospitals, 50—80% — in 15 hospitals, less than 50% — in 7 hospitals. Less than 5% of ventilators have been out of order throughout the pandemic in 62 ICUs, 5—10% — in 20 departments, over 10% — in 18 ICUs. High-flow oxygen therapy was not available in 48 ICUs, ultrasound — in 10 ICUs. ECMO was available only in 17 ICUs. If we consider the pandemic as a model of health system response to non-standard global challenges, these data are essential for critical analysis despite small sample size. © 2021, Media Sphera Publishing Group. All rights reserved.