Interrelation between the parameters of endogenous vascular regulation, oxidative stress and the markers of inflammatory response in COVID-19 patients while on extracorporeal membrane oxygenation

Introduction. Extracorporeal membrane oxygenation has found wide application in clinical practice during the COVID-19 pandemic. Oxidative stress, endothelial dysfunction, and systemic inflammatory response syndrome play an important role in the pathogenesis of COVID-19. Our research was designed to study correlations in-between those factors and the impact of extracorporeal membrane oxygenation on them. Aim. The study of systemic inflammatory response and endothelial function in patients with COVID-19 during extracorporeal membrane oxygenation. Material and methods. In the course of a prospective study, we examined 100 COVID-19 patients aged 26 to 75 years, median 55 years [47;60], who were treated at the N.V. Sklifosovsky Research Institute for Emergency Medicine, using extracorporeal membrane oxygenation. As a control group (normal), 25 practically healthy people whose median age was 32 years [25;39] were examined. The function of the vascular endothelium was assessed by the content of nitric oxide stable metabolites in the blood serum and the level of angiotensin-converting enzyme. Next, the ratio of nitric oxide metabolite to angiotensin-converting enzyme level was calculated, reflecting the imbalance between endothelium-dependent vasodilation and vasoconstriction. To assess the severity of oxidative stress in blood serum, malondialdehyde was determined as a marker of lipid peroxidation. The state of the antioxidant system was assessed in terms of total antioxidant status of blood serum. The presence of an imbalance in the system of lipid peroxidation and the antioxidant system total antioxidant status was judged by the oxidative stress coefficient, i.e. the ratio of malondialdehyde to the total antioxidant activity. Results. The analysis showed the presence and progression of endothelial dysfunction, impaired vascular regulation, activation of free radical processes, the presence of an imbalance in the prooxidant/antioxidant system, as well as the progression of the inflammatory process with a decrease in the level of markers of the COVID-19 severity. Conclusion. Further studies of the correlation between endothelial damage and the severity of the systemic inflammatory response syndrome may be of fundamental importance for explaining the pathophysiological mechanisms of COVID-19 course and developing new treatments for such patients. © 2023 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Anti-Interferon Alpha Autoantibodies and Their Significance in Covid-19

During the last two years, treatment of patients with novel coronavirus infection COVID-19 remains an urgent health problem. Interferon proteins are known to play a significant role in antiviral immunity. Some pathological conditions are accompanied by production of neutralizing autologous immunoglobulins against own host interferons (autoIFN-Abs). There is evidence that autoantibodies against interferons alpha and omega are detected in patients with life-threatening course of COVID-19 pneumonia. The aim of our study was to analyze prevalence of autoantibodies against interferon alpha in patients with COVID-19 coronavirus infection and assess their impact on clinical course of the disease. We examined 70 patients with severe COVID-19, who received inpatient treatment at the intensive care units. Serum autoantibodies against interferon alpha were determined on day 8-50 after disease onset by using solid-phase enzyme immunoassay ( ELISA). Patients were divided into 2 groups: those with and without (group 2) autoantibodies against interferon alpha (group 1). Anti-COVID serum from 57 donors was used a control. Among patients, autoantibodies against interferon alpha were detected in 13 (18%) subjects, which level ranged from 26.8 to 1000 ng/ml. Among donors, autoIFN-Abs were detected in 5 (8.8%) subjects at trace concentrations (from 1.65 to 12.0 ng/ml). Respiratory failure developed significantly more often in patients with auto-IFN-Abs. While analyzing laboratory parameters, it was noted that the concentration of C-reactive protein was significantly higher in the group of patients with auto-IFN-Abs. Mortality rate of patients with high auto-IFN-Abs levels was 60%. In conclusion, it was found that serum autoantibodies against IFN alpha in COVID-19 patients caused lung damage that significantly more often required hardware respiratory support, so comparable by duration with it for patients without auto-IFN-Abs. High concentrations of auto-IFN-Abs (more than 100 ng/ml) in patients with COVID-19 can be considered as a predictor of unfavorable disease outcome.

Regulation of lymphocyte apoptosis in intensive care patients with COVID-19

Severity of a new coronavirus infection (COVID-19) caused by the SARS-COV-2 virus is largely due to abnormal immune condi-tion in these patients. Lymphopenia is observed in 85% of patients with severe COVID-19 that may be associated with enhanced apoptosis of lymphocytes. Objective. To analyze apoptotic death of lymphocytes and changes in proteins regulating apoptosis in patients with severe COVID-19. Material and methods. We analyzed 93 ICU patients. All patients were divided into three groups depending on severity and outcomes of disease: group 1 consisted of 53 patients with favorable course and outcomes of disease, group 2 included 26 patients with unfavorable course and favorable outcomes of disease, group 3 included 14 patients with unfavorable course and outcomes of disease. Blood sampling for analysis of apoptosis markers was carried out in 5-12 and 14-18 days after clinical manifestation of disease. Quantitative parameters of lymphocyte apoptosis were evaluated using flow cytometry. Regulatory proteins of apop-tosis (phosphorylated AKT, JNK, BAD, BCL-2, p-53, active caspase 8 and 9) were determined on the Luminex platform. We also assessed concentration of leukocytes, relative and absolute lymphocyte count, concentration of C-reactive protein (CRP), procal-citonin and lactate dehydrogenase. Results. Study groups significantly differed in NEWS score (p=0.001), SOFA score (p=0.001), CRP level (p=0.001), severity of lymph-openia (p=0.001) and level of CD14+HLA-DR+ monocytes (p=0.001). Quantitative parameters of lymphocyte apoptosis did not cor-relate with lymphopenia. The highest rates of lymphocyte apoptosis were observed in patients with favorable course and outcomes of disease. There was no correlation between concentration of lymphocytes in venous blood and level of proteins regulating apoptosis. Conclusion. Patients with severe COVID-19 are characterized by abnormal induction of lymphocyte apoptosis through external and internal activation pathways in response to viral aggression. In deceased patients, pro-apoptotic factors prevailed while activity of anti-apoptotic factors was decreased. © 2023, Media Sphera Publishing Group. All rights reserved.

Specific Changes in Hemostasis System Parameters during Extracorporeal Membrane Oxygenation in Patients with a Novel Coronavirus Infection

Extracorporeal membrane oxygenation (ECMO) is a method that makes it possible to compensate for critical changes caused by acute respiratory failure, with the ineffectiveness of treatment with rigid modes of artificial lung ventilation (ventilator) in patients with acute respiratory distress syndrome in intensive care units. The search for the optimal state of the hemostasis system is one of the main tasks in the treatment of critical patients in ECMO conditions. The objective: to study changes in hemostatic parameters in patients with COVID-19 undergoing ECMO and determine the need for their correction. Subjects and Methods. According to the inclusion and exclusion criteria, 100 patients were included in the study: 72 men and 28 women aged 26 to 75 years old, the median age made 55 years [47;60]. VV-ECMO was performed in all observations. In 100% of cases, the cause of respiratory failure which required VV-ECMO was COVID-19-associated pneumonia. Results. 49 episodes of hemorrhagic complications and 76 episodes of thrombotic complications were recorded from the 1st to the 7th day from the moment of ECMO initiation. We found that the chance of developing thrombosis decreased by an average of 0.3% with an increase in the activity of antithrombin-3 by 1%. A statistically significant association of thrombosis risk was also found for prothrombin and prothrombin time. Conclusion. During the first 7 days of ECMO, patients with COVID-19 demonstrate the increase in APTT, prothrombin time and a decrease in the number of platelets, prothrombin activity, and fibrinogen concentration. The risk of thrombosis in this group of patients significantly decreases with the increasing activity of antithrombin-3 and prothrombin and increases with rising need of the higher dose of unfractionated heparin. The tactics of restrictive anticoagulant therapy when using unfractionated heparin can be taken into account as a way to reduce the risk of thrombosis and requires further research. © 2022 The authors.

Course and Outcomes of Acute Coronary Syndrome in the Presence of New Coronavirus Infection COVID-19

We analyzed the clinical condition of patients with COVID-19 of varying severity, changes in instrumental and laboratory parameters, and assessed the impact of the severity of the course of a new coronavirus infection on the outcomes of acute coronary syndrome. AIM OF STUDY To study the mutual influence of acute coronary syndrome and the new coronavirus infection COVID-19 on the nature of the course and outcomes of the disease. MATERIAL AND METHODS In March 21, 2020 - May 31, 2021, 3 625 patients were treated for COVID-19, including 131 patients with acute coronary syndrome due to COVID-19 disease. All patients underwent a number of studies: computed tomography of the chest, electrocardiography, echocardiography, monitoring of biomarkers of myocardial damage, diagnostic coronary angiography and, if necessary, intracoronary therapeutic intervention. RESULTS Data on the distribution of patients with COVID-19 according to the presence or absence of ST segment elevation on the electrocardiogram and the degree of lung tissue damage, as well as information on mortality in these groups, are presented. The role of troponin I in the assessment of myocardial ischemia was analyzed. The direct dependence of its level on the volume of lung damage was found. The inverse relationship was shown between the degree of damage to the lung tissue and the indices of oxygen saturation in the blood. A poor prognostic value of low left ventricular ejection fraction in patients with COVID-19 disease has been described. CONCLUSIONS The development of acute coronary syndrome in the course of COVID-19 significantly worsens the prognosis of the disease, which requires the development of algorithms for providing medical care to patients in this category, as well as maximum vigilance in their treatment. © 2022 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Functional and quantitative computed tomographic changes in the bronchopulmonary system in patients who have undergone COVID-19

Introduction. COVID-19 is a highly contagious infectious disease caused by the novel coronavirus SARS-CoV-2. After the acute phase and discharge from the hospital, convalescent people continue to have respiratory symptoms, changes in pulmonary function (PF) and indicators of chest computed tomography (CT). Aim. To evaluate changes in PF and quantitative CT data in patients after severe coronavirus pneumonia. Materials and methods. A cross-sectional observational study was conducted: 55 patients (including 28 men, aged 32–78 years) with a diagnosis of “lung interstitial process due to a coronavirus infection” were examined. All patients underwent a study of PF (spirometry, body plethysmography, measurement of the diffusion lung capacity: DLCO ) in the interval of 24–305 days after discharge from the hospital. CT scan of the chest was performed simultaneously with the functional examination (±30 days), the parameters were calculated: ground glass areas, functional lung tissue volume (FV), affected tissue volume (AV), CovidQ (AV/FV ratio). Results. A decrease in DLCO was found in 28 patients. Restrictive disorders – in 13 patients, obstructive disorders – in 2 patients. At the time of the CT examination, all patients had residual changes in both lungs of varying severity. Functional parameters (FVC, TLC and DLCO ) were statistically significantly correlated with the CT data. Conclusion. During the recovery period in patients after COVID-19, lung structural changes, according to CT scans, persist for at least 3 months. Pulmonary ventilation indicators in most patients normalize during this time, half of the patients retained a decrease in diffusion lung capacity. © 2022, Remedium Group Ltd. All rights reserved.

Effect of vitamin D (25-OH D3 ) concentration on the course and outcomes of COVID-19 in intensive care patients

Objective. To study the effect of vitamin D concentration on the course and outcomes of COVID-19 in intensive care patients. Material and methods. A prospective study included 43 ICU patients admitted to the Sklifosovsky Research Institute for Emergency Care with a confirmed diagnosis of a novel coronavirus infection. Single blood sampling was performed in 1—2 days after admission for analysis of 25-OH D3 concentration. Patients were divided into 2 groups with normal and reduced level of vitamin D. We analyzed chest CT data and laboratory parameters at admission and at the peak of cytokine storm. Administration of IL-6 antagonists and IL-6 receptor blockers was compared. We also compared the need for respiratory support, period between the onset of disease and respiratory therapy, its total duration and type of respiratory support, incidence of complications (sepsis, multiple organ failure, nosocomial pneumonia, acute kidney injury, thrombosis and hemorrhagic events). We analyzed the outcomes of disease, length of ICU-stay and hospital-stay. Results. Patients with normal vitamin D level at admission were characterized by lower serum C-reactive protein (15.41±7.96 vs. 63.271±11.988;p=0.029), while lymphocyte count (1.69±0.49 vs. 0.921±0.0719;p=0.029), leukocyte count (7.88±1.33 vs. 5.305±0.468;p=0.041) and serum lactate dehydrogenase (454.50±102.5 vs. 271.315±16.867;p=0.024) were higher. Minimum daily saturation at the peak of cytokine storm was higher in patients with normal vitamin D level (95.2±1.39 vs. 90.947±0.9585;p=0.044). Conclusion. Patients with vitamin D deficiency have a more pronounced inflammatory response in initial stages of disease and more severe lung damage at the stage of cytokine storm. However, this does not increase aggressiveness and duration of respiratory support, ICU-and hospital-stay. There was no worsening of the outcomes too. © S.S. PETRIKOV1, G.E. SAVKOV1, M.A. GODKOV1, N.V. BOROVKOVA1, A.M. KVASNIKOV1, D.A. LEBEDEV1, K.V. KISELEV2, K.A. POPUGAEV1.

Intensive Care of Patients with COVID-19.

The severe course of COVID-19 requires treatment in emergency and intensive care units. Acute respiratory failure due to the development of pneumonia and acute respiratory distress syndrome is the most common and life-threatening manifestation of the new coronavirus infection. Treatment of patients with severe and extremely severe COVID-19; the use of modern schemes and protocols for drug therapy, mechanical ventilation, and extracorporeal membrane oxygenation; sorption techniques; the use of thermal helium; hemostasis correction; and rehabilitation problems are discussed.

ANTI-INTERFERON ALPHA AUTOANTIBODIES AND THEIR SIGNIFICANCE IN COVID-19

During the last two years, treatment of patients with novel coronavirus infection COVID-19 remains an urgent health problem. Interferon proteins are known to play a significant role in antiviral immunity. Some pathological conditions are accompanied by production of neutralizing autologous immunoglobulins against own host interferons (auto-IFN-Abs). There is evidence that autoantibodies against interferons alpha and omega are detected in patients with life-threatening course of COVID-19 pneumonia. The aim of our study was to analyze prevalence of autoantibodies against interferon alpha in patients with COVID-19 coronavirus infection and assess their impact on clinical course of the disease. We examined 70 patients with severe COVID-19, who received inpatient treatment at the intensive care units. Serum autoantibodies against interferon alpha were determined on day 8–50 after disease onset by using solid-phase enzyme immunoassay (ELISA). Patients were divided into 2 groups: those with and without (group 2) autoantibodies against interferon alpha (group 1). Anti-COVID serum from 57 donors was used a control. Among patients, autoantibodies against interferon alpha were detected in 13 (18%) subjects, which level ranged from 26.8 to 1000 ng/ml. Among donors, auto-IFN-Abs were detected in 5 (8.8%) subjects at trace concentrations (from 1.65 to 12.0 ng/ml). Respiratory failure developed significantly more often in patients with auto-IFN-Abs. While analyzing laboratory parameters, it was noted that the concentration of C-reactive protein was significantly higher in the group of patients with auto-IFN-Abs. Mortality rate of patients with high auto-IFN-Abs levels was 60%. In conclusion, it was found that serum autoantibodies against IFN alpha in COVID-19 patients caused lung damage that significantly more often required hardware respiratory support, so comparable by duration with it for patients without auto-IFN-Abs. High concentrations of auto-IFN-Abs (more than 100 ng/ml) in patients with COVID-19 can be considered as a predictor of unfavorable disease outcome.

Results of RT-PCR test for the presence of SARS-CoV-2 in multiple organs of post-COVID patients who died from causes other than COVID-19

The aim of this research work was to study the ability of SARS-CoV-2 to persist in multiple organs of people who have recovered from COVID-19. For this purpose, autopsy material was used from patients with a history of COVID-19 who died from causes unrelated to a new coronavirus infection. Autopsy material collected from 11 different organs was analyzed for the presence of SARS-CoV-2 RNA using real-time polymerase chain reaction (RT-PCR). Among the organs tested, SARS-CoV-2 RNA persisted longest in the bronchi and lungs. Thus, in both patients tested positive more than 100 days after recovery, SARS-CoV-2 RNA was detected only in the bronchi and lungs. On the contrary, the shorter the recovery time was, the more organs were found to have SARS-Cov-2 RNA. SARS-CoV-2 RNA was most frequently detected in biomaterials of deceased people over 80 years of age, which may indicate a longer period of virus elimination in the elderly. No correlation between the distribution of SARS-CoV-2 across organs and the age of patients could be detected, but it was shown that SARS-CoV-2 persisted in more organs in males after recovery. In females, SARS-CoV-2 RNA was found predominantly in the bronchi and lungs.

[Long-term follow-up study of post-COVID-19 patients].

AIM: To evaluate dynamic changes in the lungs, hemostasis system, immune system in different terms after coronavirus pneumonia. MATERIALS AND METHODS: Ventilation-perfusion single-photon emission computed tomography/computed tomography (CT), functional methods of lung investigation, evaluation of hemostasis system, immune status and specific humoral immune response were performed and evaluated in different terms after coronavirus pneumonia. A total of 71 patients were examined according to this protocol. We examined patients with the lesion volume not less than 50% according to chest CT. All patients were divided into 2 groups depending on the distance from the acute stage of coronavirus pneumonia. Group 1 included patients who were examined early (3060 days after hospital discharge), group 2 included patients who were examined later (61180 days after hospital discharge). RESULTS: We obtained gradual regression of pathologically-modified tissue from 67.3% during the inpatient phase to 30.9% during the early period and to 19.7% during the late period of examination, according to CT scan of the chest organs. The same tendency was demonstrated by diffusion capacity of the lungs. Perfusion scintigraphy data showed a decrease in perfusion deficit from 26.012.8% during the early period of examination to 19.46.2% during the late period of examination. On the contrary, ventilatory scintigraphy demonstrates the increase of isotope passage time through the alveolar-capillary membrane over time (from 48.231.3 minutes in the early period to 83.637.2 minutes in the late period). An increase in D-dimer was detected in 24% of patients in the early group. The levels of inflammatory markers, indices of immune status, and specific humoral immune response did not differ in the two described groups. CONCLUSION: The results demonstrate gradual regression of pathological changes caused by coronavirus infection.

Antithrombin-III for New Coronavirus Infection (COVID-19) Under Conditions of Extracorporeal Membrane Oxygenation (Clinical Observation

COVID-19 is a disease that, in addition to respiratory failure, leads to thrombosis and bleeding due to coagulation disorders. Extracorporeal membrane oxygenation (ECMO), required in cases of a deterioration of gas exchange function of the lungs, contributes to changes in blood coagulation indicators, which leads to an increased risk of hemorrhagic complications and thrombosis. In the article, a clinical case of a severe course of COVID-19 is reported, which required ECMO. During the treatment, antithrombin-III was used, which allowed avoiding life-threatening complications and successfully completing the procedure. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

A multidisciplinary approach to the treatment of COVID-associated complications after pancreatoduodenal resection (case report)

We report a clinical case of treatment of a complicated postoperative course in a patient who underwent pancreatoduodenal resection associated with coronavirus infection. Prevention and treatment of such complications have been suggested. Pancreatoduodenal resection (PDR) is indicated for malignant tumors of the pancreatic head, duodenum or its large papilla, distal common bile duct, as well as in chronic pancreatitis with a predominant lesion of the pancreatic head with severe pain syndrome. The given clinical observation describes an example of treatment of a patient who developed a series of thromboembolic complications in the early stages after PDR performed for a neuroendocrine tumor of the pancreatic head. The oncology disease, extensive surgery such as PDR, and the postoperative period itself are risk factors for the development of various thromboembolic complications. According to the literature, the incidence of thromboembolic complications after PDR is 3–3.3%. The reason for the atypical course of the postoperative period when performing pancreatoduodenal resection in patients with tumor of the pancreas may be conditions that are not directly related to either the pathology of the pancreas or the features of the surgical intervention. When analyzing the patient’s condition, one should take into account the conditions of treatment. In such situations, proper detection of COVID-19 and adequate correction of therapy can fundamentally change the outcome of the disease. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

COVID-19 and cardiovascular system. Part 3. COVID-19 current treatment approaches: Evidence-based review

Unified management plan and treatment strategy for COVID-19 patients are yet to be discovered. Many trials on COVID-19 interventions have been registered or are ongoing. In this article the results of large-scale clinical trials on COVID-19 treatment are presented, the potential mechanism of action of some drugs is discussed, the features of the main pharmacological and non-pharmacological therapeutic options for COVID-19 patients are described. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

COVID-19 and cardiovascular system. Part II. Post-COVID syndrome

Long-term consequences of COVID-19 remain the subject of active research interest. In this article the Post-COVID-19 syndrome (PCS) main features and symptoms are considered, its incidence and link with comorbidity is presented and the possible mechanisms are discussed. Due to the damage COVID-19 has on lungs, heart, brain and other systems, patients with PCS require multidisciplinary management. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Biomarkers of air-blood barrier damage in covid-19

The search for sensitive and specific markers enabling timely identification of patients with a life-threat-ening novel coronavirus infection (COVID-19) is important for a successful treatment. The aim of the study was to examine the association of molecular biomarkers of air-blood barrier damage, surfactant proteins SP-A and SP-D and Club cell protein CC16, with the outcome of patients with COVID-19. Materials and methods. A cohort of 109 patients diagnosed with COVID-19 was retrospectively divided into two groups. Group 1 comprised survivor patients discharged from the ICU (n=90). Group 2 included the patients who did not survive (n=19). Association of disease outcome and SP-A, SP-D, and CC16 levels in blood serum, clinical, and laboratory data were examined taking into account the day of illness at the time of bio-material collection. Results. The non-survivors had higher SP-A (from days 1 to 10 of symptoms onset) and lower CC16 (from days 11 to 20 of symptoms onset) levels vs survivors discharged from ICU. No significant differences in SP-D levels between the groups were found. Conclusion. According to the study results, the surfactant protein SP-A and Club cell protein CC16 are associated with increased COVID-19 mortality.

MENTAL HEALTH AND PROFESSIONAL BURNOUT AMONG RESIDENTS DURING THE COVID-19 PANDEMIC: SITUATIONAL AND PSYCHOLOGICAL FACTORS

The paper presents the results of a study of the level and factors of mental maladjustment and professional burnout of medical residents undergoing training at the Training Center of N.V. Sklifosovsky Research Institute for Emergency Medicine during the second wave of the COVID-19 pandemic. The study involved 110 first and second year residents (30 men and 80 women;mean age - 25.1 +/- 2.32), both working in the COVID-19 "red zone" and helping other patients. The following methods were used to assess symptoms and factors of mental maladjustment and professional burnout: Beck Depression and Anxiety Scales (Beck et al., 1988;1996), Maslach Burnout Inventory (Maslach & Jackson, 1981), PTSD Checklist for DSM 5 (PSL-5;Weathers et al., 2013) Distress Thermometer (Holland, Bultz, 2007), UCLA Loneliness Scale (Russell et al., 1978) Three-Factor Perfectionism Inventory (Garanyan et al., 2018) and Toronto Alexithymia Scale (Taylor et al., 2003). According to the data, 43% of young doctors noted symptoms of depression of moderate and high severity, suicidal thoughts were present in 10%, symptoms of heightened anxiety in 30%, and more than a half (55%) had critically high rates of symptoms of post-traumatic stress. About a quarter of the respondents showed high rates of general distress (24%) and professional burnout in all three of its aspects (emotional exhaustion - 21%, depersonalization - 23%, and personal accomplishment - 22%). Most residents associated distress with difficulties in combining work and study and fear for the quality of education during the pandemic. Social support was noted as a factor in coping with stress. A series of regression analyzes showed the importance of the contribution of the experience of loneliness, as well as high rates of perfectionism and alexithymia, to mental distress and professional burnout of residents.

COVID-19 and cardiovascular system: Pathophysiology, pathomorphology, complications, long-term prognosis

AIM OF STUDY Like other respiratory viruses, COVID-19 has extrapulmonary manifestations. The effect of the virus leads to the cardiovascular system (CVS) damage in particular, which pathophysiological mechanisms are not fully understood. In this article we analyze modern ideas about COVID-19, consider possible links of pathogenesis, make an attempt to systematize pathophysiological mechanisms of cardiovascular impairment and its complications, analyze the relation with cardiovascular comorbidity, describe pathomorphological features and discuss possible long-term prognosis. The information in this article can contribute to understanding the two-way interaction of cardiovascular diseases and the effects of COVID-19 in order to develop effective preventive measures and make the right decision in choosing therapeutic tactics for a patient. © 2021 Sklifosovsky Research Institute for Emergency Medicine. All rights reserved.

Hyperbaric oxygen therapy in patients with COVID-19

The aim of the study is to evaluate the efficacy of hyperbaric oxygen therapy and its effect on oxidative stress and apoptosis in patients with new coronavirus infection COVID-19. Materials and methods. 90 patients diagnosed with new coronavirus infection caused by SARS-CoV-2 virus were examined. Hyperbaric oxygen therapy sessions were conducted in 57 patients (38 in severe condition (CT 3–4), 19 in moderate condition (CT 1–2)). The procedures were performed in 1.4–1.6 ATA mode for 40 min-utes, 247 sessions in total were performed. The effect of hyperbaric oxygenation was assessed by measuring the level of oxygen saturation, the severity of oxidative stress and apoptosis of blood lymphocytes. Results. In all examined patients with new coronavirus infection caused by SARS-CoV-2, positive changes such as dyspnea reduction and improvement of general well-being were registered after hyperbaric oxygen therapy sessions. The level of oxygen saturation after the end of the hyperbaric oxygen therapy course was 95.0±1.6% (before the course — 91.3±5.9%), which allowed to return almost all patients to spontaneous res-piration without the need for further oxygenation therapy. Hyperbaric oxygen therapy did not reduce the total antioxidant activity, however, it was associated with a decrease in the blood malone dialdehyde from 4.34±0.52 µmol/l to 3.98±0.48 µmol/l and a decrease in open circuit potential of platinum electrode from-22.78±24.58 mV to-37.69±17.4 mV. Besides, the positive effect of hyperbaric oxygen therapy was manifested in normalization of blood cell apoptosis. Conclusion. Hyperbaric oxygen therapy in patients with new coronavirus infection caused by the SARS-CoV-2 virus is an effective treatment method with multiple effects resulting in improvement of subjective indicators of the patients' condition, increase of hemoglobin oxygen saturation, decrease of lipid peroxidation intensity, activation of antioxidant system, restoration of pro-and antioxidant balance and apoptosis normalization. © 2020, V.A. Negovsky Research Institute of General Reanimatology. All rights reserved.

Rehabilitation of patients with covid-19 infection at the sklifosovsky research institute for emergency care

Organization of post-infection rehabilitation is an urgent problem in the context of a new coronavirus infection pandemic. Algo-rithm for protection of patients and staff is usually described in the literature. At the same time, rehabilitation process is not ana-lyzed. Therefore, experience exchange is advisable. Objective. To summarize the experience of rehabilitation of patients with COVID-19 infection at the intensive care unit of the Skli-fosovsky Research Institute for Emergency Care. Material and methods. The study included 39 patients with COVID-19 infection in severe and extremely severe condition. Mean age was 60 (52;67.5) years. Mechanical ventilation was required in 14 (35.9%) patients. All patients underwent rehabilitation around the clock. Results. The rehabilitation program was determined for each patient within 48 hours after admission. Rehabilitation measures included positioning (including pron-position), verticalization, mechanotherapy, physiotherapy exercises, breathing exercises, and psychological support. In this manuscript, we describe the organization of rehabilitation and its features. There were 674 physiotherapy exercises (excluding positioning) and 233 physiotherapy procedures. Each patient underwent 2—3 physiotherapy procedures per day. Patients under mechanical ventilation underwent all rehabilitation procedures without any features of toler-ance or effectiveness. Psychological care was required for difficult adaptation to in-hospital conditions, advanced anxiety and im-paired mood. We have developed a guide on stress management for medical staff and effective communication with patients. Conclusion. Organization of the intensive care unit of infectious building at the Sklifosovsky Research Institute for Emergency Care is close to the international recommendations of experts. Specialists have developed the new methods of working with patients. © 2020, Media Sphera. All rights reserved.