ABSTRACT
Before the COVID-19 pandemic, only the so-called «trophic» enteral tube feeding was recommended in critically ill patients on extracorporeal membrane oxygenation (ECMO). Since ECMO has been carried out for a short time in most cases, there are almost no clinical guidelines on nutritional support for patients eligible for long-term extracorporeal life support. In this report, we present a part of multidirectional intensive care in a patient with extremely severe COVID-19 associated respiratory failure. A particular attention is paid to metabolic status, nutritional support and enteral oxygen therapy during ECMO. The most principal provisions characterizing specifics of enteral nutritional support combined with intestinal oxygen therapy in a patient on veno-venous ECMO are highlighted. © 2022, Media Sphera Publishing Group. All rights reserved.
ABSTRACT
The host immune response, primarily manifested by hypercytokinemia, obviously plays a key role in the development of severe novel coronavirus disease, COVID-19. Currently, numerous therapies aimed at suppressing the hyperinflammatory response and the «cytokine storm» are being investigated. One of these methods is the use of corticosteroids, particularly dexamethasone. The aim was to assess the clinical efficacy of dexamethasone in patients with moderate bilateral multifocal pneumonia caused by SARS-CoV-2 virus. Material and methods. Sixty-nine patients aged from 31 to 88 years hospitalized in Almazov National Research Center and the Semashko City Hospital No 38 with SARS-CoV-2 coronavirus infection complicated by moderate (semiquantitative visual pulmonary lesion grading system CT 2–3 corresponding to 25–50% and 50–75% parenchymal involvement, respectively) community-acquired bilateral multifocal pneumonia were retrospectively studied. Group 1 included 39 patients with moderate coronavirus infection who received therapy according to the current version of the temporary guidelines (TG) of the Ministry of Health of the Russian Federation, including dexamethasone. The drug was administered parenterally twice daily in a dosage of 12 mg in the morning and 8 mg in the evening for the first three days, then the dose was gradually reduced over 5–7 days. No Interleukin-6 inhibitors were administered to patients in this group. Group 2 was composed of 30 patients who received therapy according to the current version of TG, including a parenteral interleukin-6 inhibitor (tocilizumab, olokizumab, or sarilumab) following the standard regimen. Patients in this group were not administered with dexamethasone. Results. CT scans corresponding to severity grade 3 and 4 (50–75% and >75% involvement, respectively) lung lesions on Day 7 were found in 35.89% of group 1 patients, while similar CT scans were found in 50% of patients who received interleukin-6 inhibitors (P=0.33). On Day 14 no significant differences in this parameter were revealed as well. Duration of fever in the dexamethasone group was 3.69 (0.62;6.76) days, while in the control group it was 3.95 (0.61;7.29) days (P=0.98). There was a tendency to decreased blood C-reactive protein (CRP) values in the dexamethasone group on days 5 and 7. The frequency of transfer of patients to the ICU and hospital stay duration did not differ significantly between the groups. Conclusion. Dexamethasone has comparable clinical efficacy with IL-6 antagonists in the comprehensive treatment of patients with moderate COVID-19 disease, which is confirmed by the chest CT evolution, duration of fever, and changes in serum CRP. © 2022, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.
ABSTRACT
Introduction. Catabolic syndrome is typical for most critical illness situations. A long progressive course of hypercatabolism is considered by a number of authors as a prognostic criterion for negative clinical outcome of the disease. Objective. Evaluation of the prognostic value of some indicators of the severity of catabolic syndrome in ICU patients with COVID-19. Materials and methods. A prospective cohort study was conducted in 55 patients of the intensive care unit in the period from May 2020 to March 2021. The severity of hypercatabolism was determined by the dynamics of serum albumin and daily urinary nitrogen excretion within 14 days from admission to the ICU. Comparative analysis of nonparametric quantitative data was carried out using the Mann–Whitney test. To determine the predictive value of the diagnostic test, we plotted using the curves of operating characteristics (ROC, Receiver Operating Characteristics) with the subsequent determination of the sensitivity and specificity at the separation point. Results. ROC analysis revealed moderate sensitivity (75.9 %) and low specificity (58.1 %) of the daily urinary nitrogen excretion during the first 14 days of treatment in the ICU in patients with severe SARS-CoV-2. It was also shown that the dynamics of serum albumin has a low predictive value for negative clinical outcome. It should be noted that in the group of survived patients a significant increase in daily urinary nitrogen excretion was observed on days 4–7 (p = 0.022) and 8–14 (p = 0.01) of intensive therapy. Conclusion. Nitrogen urinary excretion is a more accurate prognostic marker of poor clinical outcome than serum albumin in ICU patients with severe COVID-19. The main feature of the catabolic syndrome in patients with positive clinical outcome is a progressive increase in the rate of urinary nitrogen excretion from 4 to 14 days after admission to ICU. © 2021, Practical Medicine Publishing House LLC. All rights reserved.
ABSTRACT
The novel coronavirus infection is a global pandemic with a continuing upward trend for global cases. The virus can infect any person;however, pregnant women may be more susceptible due to physiological changes in the body. This paper describes a clinical case of the rapid course of COVID-19 pneumonia in a pregnant patient without substantial risk factors for a severe, complicated form of the disease. Patient Zh. was infected with COVID-19 at 37-38 weeks’ gestation. The first clinical manifestations of the disease were sore throat accompanied by a rise in temperature up to 38° C. Taking into consideration that the patient felt worse, cough and fever appeared, she was admitted to a specialized hospital on day 5 after the onset of the disease. On day 7 of hospitalization, worsening respiratory symptoms and intoxication syndrome led to the development of acute cardiopulmonary failure that was the cause of death in the pregnant woman and her fetus. Despite the relatively small number of maternal deaths due to COVID-19, obstetricians/gynecologists and other health care workers need additional data on the characteristics of the course of the disease and possible adverse maternal and perinatal outcomes. Conclusion. Physicians should be informed about mortality and its associated clinical characteristics in patients mainly because the median time from the onset of symptoms of the infectious process to the fatal outcome can be as little as two weeks. © A group of authors, 2021.