Keywords
SARS-CoV-2
pulmonary shunt
change in dead space volume
intensive therapy regimen
treatment
drug combination
How to Cite
Abstract
Introduction. Given the lack of effective specific antiviral therapy for COVID-19, the main focus is currently on symptomatic and respiratory support. Almost all hospitalized patients are recommended to undergo oxygen therapy, while the WHO recommended extracorporeal membrane oxygenation for patients with refractory hypoxemia.
Aim. To analyze the complex of intensive care in patients with COVID-19, to evaluate the results of respiratory support and treatment.
Materials and methods. In the SIS «CHIT» SAD for the period from 09/10/2020 to 05/10/2021, 332 patients were treated. There were 22 deaths among the patients. The mortality rate was 6.6%. A total of 327 patients were admitted to the infectious intensive care unit and were treated there. Of these, 277 patients were classified as having moderate disease, and 50 as severe disease. Despite the full range of treatment, including respiratory therapy, the condition of 58 patients with moderate severity and 42 patients classified as severe progressively deteriorated, requiring their transfer to the intensive care unit. Thus, a total of 100 patients were transferred from the infectious intensive care unit to the intensive care unit, of whom 17 (17%) died. In addition, 5 critically ill patients with multiple organ failure syndrome were admitted to the intensive care unit directly from the admission department, who subsequently died. Of the 277 patients with moderate severity and 100 patients classified as severe, 219 and 83 patients, respectively, were successfully treated and discharged home. In patients with COVID-19, SpO2, ECG, heart rate, respiratory rate, blood pressure and body temperature were monitored. Chest CT scan, humoral studies for the diagnosis of cytokine storm (CRP, IL-6, D-dimer) were performed. The experience of treating patients with COVID-19 was analyzed.
Results. The algorithm for providing care for ARF included a step-by-step approach in choosing respiratory therapy for COVID-19. The recommended criterion for the effectiveness of mechanical ventilation, drug therapy and process dynamics is the ratio of total dead space ventilation per minute to total lung ventilation per minute [VD (ml/min)/VE (ml/min)]. The average value of the VD/VE indicator is about 0.3. It has been proven that as the process progresses and the condition worsens, it increases, and as lung function is restored and ARDS is eliminated, it decreases.
Conclusions. Of the 332 patients with COVID-19 hospitalized and treated at the SIS «CIHT» SAD for the period from 01.02.2021 to 01.06.2021, 310 patients were discharged. The mortality rate was 6.6%.
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