Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

ABSTRACT

Intensive therapy of severe COVID-19 is one of the most difficult problems of modern intensive care. Objective. To assess the effectiveness of clinical guidelines in the treatment of severe forms of a new coronavirus infection in children. Material and methods. A retrospective controlled non-randomized multiple-center study enrolled 111 ICU children from 40 hospitals. Specialists of the Federal Remote Intensive Care Counselling Centre counseled all patients. Children were divided into 2 groups («recovery» and «death») depending on the outcome. Results. pSOFA score 2 (1—5) at admission was associated with 19.5-fold increase of mortality risk (OR 19.5, 95% Cl 2.3—165.7). We found higher score «respiratory distress» item in all patients regardless the outcome. Antibacterial, corticosteroid therapy and vasopressor support significantly affected the outcome of disease (X2=18.202;df=3, p=0.000), while infusion, respiratory, anticoagulant therapy and enteral nutrition were less significant, especially in pSOFA score ≤4 points (X2=15.521;df=5, p=0.008). Mortality risk decreased in no need for increase of initial doses of catecholamines (OR 0.2, 95% 0=0.1—0.7). Less compliance with recommendations for correction of antibacterial and corticosteroid therapy was followed by higher mortality (OR 5.2, 95% Cl 1.4—18.9 and OR 3.4, 95% Cl 1.1—10.8, respectively). Conclusion. Timely strict implementation of clinical guidelines, adequate catecholamine support, antibacterial and corticosteroid therapy in children with COVID-19 significantly reduce the likelihood of mortality. © 2022, Media Sphera Publishing Group. All rights reserved.