ABSTRACT
Introduction. During the SARS-CoV-2 pandemic, worldwide healthcare system faced a new, insufficiently investigated, fast-spreading disease with multisystem failure and relatively high amount of severe diseased. Existing evidence base needs to be frequently revisited after data accumulation and analysis. Experience of dedicated COVID-19 centers should be summarized and implicated in clinical practice according to evidence-based principles, extensive clinical trial initiation. Objectives. To investigate baseline characteristics and treatment outcomes of patients with severe SARS-CoV-2 infection course, requiring respiratory support in the critical care settings of dedicated hospital. Materials and methods. In single-center retrospective study retrospective data collection of 451 respiratory support for COVID-19 related acute respiratory distress syndrome cases (noninvasive ventilation, mechanical ventilation) in intensive care unit patients for a 5-month period performed. The analysis aimed on demographic, clinical data, disease severity scores, respiratory support parameters and modality, continuous renal replacement therapy utilization and interleukin-6 receptor blockers administration, survival rates. Results. Respiratory support required 48.8 % of intensive care unit patients, the population was demographically balanced, Charlson Comorbidity Index was 4.46 ± 2.6 and was higher in the mechanically ventilated group. 30-day survival rate (all respiratory support cases) was 33.7 %, mortality structure analysis performed. The disease severity scores, respiratory mechanics among patients in dependence of respiratory support mode and during the period of case registration analysed as well. Median static respiratory compliance at the point of initiation of invasive mechanically ventilation was 43 (IQR 35–51). Mortality in the volume controlled mechanically ventilated group was higher. Conclusions. The patients, requiring respiratory support, during intensive care unit stay have high comorbidity levels. Indications for non-invasive ventilation may be extended on patients with lower Charlson index and initial SOFA score, however, early recognition of high risk of noninvasive ventilation failure required. Volume control invasive ventilation associated with higher mortality levels despite comparable disease severity scores. Further investigation required. © 2021, Practical Medicine Publishing House LLC. All rights reserved.
ABSTRACT
Objective: To study the use of RRT methods and their influence on the results of treatment of patients with severe COVID-19. Subjects and methods. We retrospectively analyzed the data of 283 patients with COVID-19 in the intensive care units of Moscow City Hospital no. 40 in 2020 who had received RRT as one of the treatment methods. Results. Frequency of RRT in COVID-19 patients in ICU of Moscow City Hospital no. 40 for 2020 made 5.7% (504 out of 8.711 patients treated in ICU received RRT). In 86% of cases, RRT was performed for renal indications. At the time of initiation of RRT, the studied groups did not differ according to SOFA score. The frequency of using dialysis units with high and low cut-off point in the groups of survived and deceased patients differed significantly. The surgery itself started at relatively the same time from the onset and statistically significantly earlier in the group of survivors from the beginning of tracheal intubation (4.9 0.5 vs 6.8 0.3 days, p = 0.0013). Against the background of ongoing therapy, overall severity of the state progressed in the group of deceased patients to 9.9 0.2 SOFA scores, while in the group of survivors there was an improvement to 6.1 0.4 scores. © 2020 Geocarrefour. All rights reserved.