6 research outputs found
ΠΠΎΠ·ΠΎΠΊΠΎΠΌΠΈΠ°Π»ΡΠ½Π°Ρ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ COVID-19
The aim of the study was to determine the etiology and frequency of nosocomial infections in patients with severe and critical COVID-19.Material and methods. A retrospective, single-center study included 168 patients with COVID-19 admitted to the intensive care unit (ICU). All episodes of infection, clinical and laboratory characteristics, and outcome were documented in patients.Results. Hospital-acquired infections were detected in 82 (48.8%) of 168 patients, more frequently in men (p = 0.028).Β A total of 232 episodes of nosocomial infections were observed including ventilator-associated pneumonia (48.2%), bloodstream infection (39.2%), nosocomial pneumonia/tracheobronchitis (13.4%), and urinary tract infection (5.2%). The main causative agents of nosocomial infections were resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae. Infections developed on the average on day 6 [3; 9] of ICU stay and were associated with the initial severity of the patients assessed by SOFA (p=0.016), SpO2 (p=0.005), lymphopenia severity (p=0.003), Neutrophil-Lymphocyte Ratio (p=0.004), C-reactive protein (p=0.01), aspartate aminotransferase (AST) level (p=0.022), or vitamin D (p=0.035) levels. Patients diagnosed with infection were more likely than those without infections to require mechanical ventilation (67.6% vs 32.4%, p < 0.001), high-flow oxygen therapy (50.0% vs 31.0%, p = 0.020), renal replacement therapy (36.8% vs 9.3%, p = 0.003), and had longer ICU length of stay (13 [9; 18] vs 4 [2; 8], p < 0.001), hospital length of stay (19 [14; 29] vs 15 [11; 20], p = 0.001) and mortality (47 (57.3%) vs 25 (29.0%), p < 0.001).Conclusion. In patients with severe and critical COVID-19 a high incidence of nosocomial infections was found, which negatively affected the outcome. In more than half of the cases, the infection was caused by resistant strains of Gram-negative bacilli. Procalcitonin is a useful biomarker for identifying bacterial infection in patients with COVID-19.Π¦Π΅Π»Ρ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΡ. ΠΠΏΡΠ΅Π΄Π΅Π»ΠΈΡΡ ΡΡΠΈΠΎΠ»ΠΎΠ³ΠΈΡ ΠΈ ΡΠ°ΡΡΠΎΡΡ Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ COVID-19.ΠΠ°ΡΠ΅ΡΠΈΠ°Π»Ρ ΠΈ ΠΌΠ΅ΡΠΎΠ΄Ρ. Π ΡΠ΅ΡΡΠΎΡΠΏΠ΅ΠΊΡΠΈΠ²Π½ΠΎΠ΅ ΠΎΠ΄Π½ΠΎΡΠ΅Π½ΡΡΠΎΠ²ΠΎΠ΅ ΠΈΡΡΠ»Π΅Π΄ΠΎΠ²Π°Π½ΠΈΠ΅ Π²ΠΊΠ»ΡΡΠΈΠ»ΠΈ 168 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19, Π³ΠΎΡΠΏΠΈΡΠ°Π»ΠΈΠ·ΠΈΡΠΎΠ²Π°Π½Π½ΡΡ
Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠ΅ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (ΠΠ ΠΠ’). Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ Π²ΡΠ΅ ΡΠ»ΡΡΠ°ΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΠΊΠ»ΠΈΠ½ΠΈΠΊΠΎ-Π»Π°Π±ΠΎΡΠ°ΡΠΎΡΠ½ΡΡ Ρ
Π°ΡΠ°ΠΊΡΠ΅ΡΠΈΡΡΠΈΠΊΡ ΠΈ ΠΈΡΡ
ΠΎΠ΄.Π Π΅Π·ΡΠ»ΡΡΠ°ΡΡ. ΠΠ½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ Π²ΡΡΠ²ΠΈΠ»ΠΈ Ρ 82 (48,8%) ΠΈΠ· 168 ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², ΡΠ°ΡΠ΅ Ρ ΠΌΡΠΆΡΠΈΠ½ (Ρ=0,028). ΠΡΠ΅Π³ΠΎ ΡΠ΅Π³ΠΈΡΡΡΠΈΡΠΎΠ²Π°Π»ΠΈ 232 ΡΠΏΠΈΠ·ΠΎΠ΄Π° Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ: Π²Π΅Π½ΡΠΈΠ»ΡΡΠΎΡ-Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π½ΡΡ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ (48,2%), ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ ΠΊΡΠΎΠ²ΠΎΡΠΎΠΊΠ° (39,2%), Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΡΡ ΠΏΠ½Π΅Π²ΠΌΠΎΠ½ΠΈΡ/ΡΡΠ°Ρ
Π΅ΠΎΠ±ΡΠΎΠ½Ρ
ΠΈΡ (13,4%) ΠΈ ΠΌΠΎΡΠ΅Π²ΡΡ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ (5,2%). ΠΡΠ½ΠΎΠ²Π½ΡΠΌΠΈ Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»ΡΠΌΠΈ Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ Π±ΡΠ»ΠΈ ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΡΠ΅ ΡΡΠ°ΠΌΠΌΡ Acinetobacter baumannii ΠΈ Klebsiella pneumoniae. ΠΠ½ΡΠ΅ΠΊΡΠΈΡ ΡΠ°Π·Π²ΠΈΠ²Π°Π»Π°ΡΡ Π² ΡΡΠ΅Π΄Π½Π΅ΠΌ Π½Π° 6-ΠΉ [3; 9] Π΄Π΅Π½Ρ Π½Π°Ρ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π² ΠΠ ΠΠ’, Π±ΡΠ»Π° Π°ΡΡΠΎΡΠΈΠΈΡΠΎΠ²Π°Π½Π° Ρ ΠΈΡΡ
ΠΎΠ΄Π½ΠΎΠΉ ΡΡΠΆΠ΅ΡΡΡΡ ΡΠΎΡΡΠΎΡΠ½ΠΈΡ, ΠΎΠΏΡΠ΅Π΄Π΅Π»ΡΠ΅ΠΌΠΎΠΉ ΠΏΠΎ ΡΡΠ΄Ρ ΠΏΠ°ΡΠ°ΠΌΠ΅ΡΡΠΎΠ²: SOFA (p=0,016), SpO2 (p=0,005), Π²ΡΡΠ°ΠΆΠ΅Π½Π½ΠΎΡΡΠΈ Π»ΠΈΠΌΡΠΎΠΏΠ΅Π½ΠΈΠΈ (p=0,003), Π½Π΅ΠΉΡΡΠΎΡΠΈΠ»ΡΠ½ΠΎ-Π»ΠΈΠΌΡΠΎΡΠΈΡΠ°ΡΠ½ΠΎΠΌΡ ΡΠΎΠΎΡΠ½ΠΎΡΠ΅Π½ΠΈΡ (p=0,004), ΠΊΠΎΠ½ΡΠ΅Π½ΡΡΠ°ΡΠΈΠΈ Π‘-ΡΠ΅Π°ΠΊΡΠΈΠ²Π½ΠΎΠ³ΠΎ Π±Π΅Π»ΠΊΠ° (p=0,01), Π°ΡΠΏΠ°ΡΡΠ°ΠΌΠΈΠ½ΡΡΠ°Π½ΡΡΠ΅ΡΠ°Π·Ρ (p=0,022), Π²ΠΈΡΠ°ΠΌΠΈΠ½Π° Π (p=0,035). ΠΠ°ΡΠΈΠ΅Π½ΡΡ, Ρ ΠΊΠΎΡΠΎΡΡΡ
Π±ΡΠ»Π° Π΄ΠΈΠ°Π³Π½ΠΎΡΡΠΈΡΠΎΠ²Π°Π½Π° ΠΈΠ½ΡΠ΅ΠΊΡΠΈΡ, Π² ΡΡΠ°Π²Π½Π΅Π½ΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠ°ΠΌΠΈ Π±Π΅Π· ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΡΠ°ΡΠ΅ Π½ΡΠΆΠ΄Π°Π»ΠΈΡΡ Π² ΠΏΡΠΎΠ²Π΅Π΄Π΅Π½ΠΈΠΈ ΠΈΡΠΊΡΡΡΡΠ²Π΅Π½Π½ΠΎΠΉ Π²Π΅Π½ΡΠΈΠ»ΡΡΠΈΠΈ Π»Π΅Π³ΠΊΠΈΡ
(67,6 ΠΈ 32,4%, p<0,001), Π²ΡΡΠΎΠΊΠΎΠΏΠΎΡΠΎΡΠ½ΠΎΠΉ ΠΊΠΈΡΠ»ΠΎΡΠΎΠ΄ΠΎΡΠ΅ΡΠ°ΠΏΠΈΠΈ (50,0 ΠΈ 31,0%, p=0,020), Π·Π°ΠΌΠ΅ΡΡΠΈΡΠ΅Π»ΡΠ½ΠΎΠΉ ΠΏΠΎΡΠ΅ΡΠ½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ (36,8 ΠΈ 9,3%, p=0,003), ΠΈΠΌΠ΅Π»ΠΈ Π±ΠΎΠ»ΡΡΡΡ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ Π½Π°Ρ
ΠΎΠΆΠ΄Π΅Π½ΠΈΡ Π² ΠΠ ΠΠ’ (13 [9; 18] ΠΈ 4 [2; 8], p<0,001), Π±ΠΎΠ»ΡΡΡΡ ΠΏΡΠΎΠ΄ΠΎΠ»ΠΆΠΈΡΠ΅Π»ΡΠ½ΠΎΡΡΡ ΠΏΡΠ΅Π±ΡΠ²Π°Π½ΠΈΡ Π² ΡΡΠ°ΡΠΈΠΎΠ½Π°ΡΠ΅ (19 [14; 29] ΠΈ 15 [11; 20], p=0,001) ΠΈ Π»Π΅ΡΠ°Π»ΡΠ½ΠΎΡΡΡ (47 (57,3%) ΠΈ 25 (29,0%), p<0,001).ΠΠ°ΠΊΠ»ΡΡΠ΅Π½ΠΈΠ΅. Π£ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ ΡΡΠΆΠ΅Π»ΡΠΌ ΠΈ ΠΊΡΠ°ΠΉΠ½Π΅ ΡΡΠΆΠ΅Π»ΡΠΌ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ΠΌ COVID-19 Π²ΡΡΠ²ΠΈΠ»ΠΈ Π²ΡΡΠΎΠΊΡΡ ΡΠ°ΡΡΠΎΡΡ Π²Π½ΡΡΡΠΈΠ±ΠΎΠ»ΡΠ½ΠΈΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ, ΠΊΠΎΡΠΎΡΠ°Ρ Π½Π΅Π³Π°ΡΠΈΠ²Π½ΠΎ Π²Π»ΠΈΡΠ»Π° Π½Π° ΠΈΡΡ
ΠΎΠ΄ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ. ΠΠΎΠ»Π΅Π΅ ΡΠ΅ΠΌ Π² ΠΏΠΎΠ»ΠΎΠ²ΠΈΠ½Π΅ ΡΠ»ΡΡΠ°Π΅Π² Π²ΠΎΠ·Π±ΡΠ΄ΠΈΡΠ΅Π»ΡΠΌΠΈ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ ΡΠ²Π»ΡΠ»ΠΈΡΡ ΡΠ΅Π·ΠΈΡΡΠ΅Π½ΡΠ½ΡΠ΅ ΡΡΠ°ΠΌΠΌΡ Π³ΡΠ°ΠΌΠΎΡΡΠΈΡΠ°ΡΠ΅Π»ΡΠ½ΡΡ
ΠΏΠ°Π»ΠΎΡΠ΅ΠΊ. ΠΡΠΎΠΊΠ°Π»ΡΡΠΈΡΠΎΠ½ΠΈΠ½ ΡΠ²Π»ΡΠ΅ΡΡΡ ΠΏΠΎΠ»Π΅Π·Π½ΡΠΌ Π±ΠΈΠΎΠΌΠ°ΡΠΊΠ΅ΡΠΎΠΌ Π΄Π»Ρ ΠΈΠ΄Π΅Π½ΡΠΈΡΠΈΠΊΠ°ΡΠΈΠΈ Π±Π°ΠΊΡΠ΅ΡΠΈΠ°Π»ΡΠ½ΠΎΠΉ ΠΈΠ½-ΡΠ΅ΠΊΡΠΈΠΈ Ρ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ² Ρ COVID-19
Π’ΡΡΠ΄Π½ΠΎΡΡΠΈ Π»Π΅ΡΠ΅Π½ΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΠΈ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ ΠΏΠΎΡΠ»Π΅ COVID-19. ΠΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ
The severe course of the new coronavirus infection (COVID-19) is associated with multiple life-threatening complications that lead to delayed initiation of active rehabilitation and unfavorable long-term treatment outcomes. Tracheoesophageal fistula is one of these complications. The specific feature of this event in COVID-19 is delayed tissue regeneration which requires a non-standard approach to management of such patients.The article presents a clinical case of a pregnant patient after a complicated severe course of COVID-19 with the development of tracheoesophageal fistula, sepsis, and weakness syndrome acquired in ICU. The combination of complications of the disease led to a prolonged (about five months) period of rehabilitation.Modern standard components of intensive therapy of such patients including regular monitoring of endotracheal/tracheostomy tube cuff pressure, dynamic assessment of nutritional status and its correction, rational antimicrobial therapy, screening of psychiatric disorders and early rehabilitation, will minimize the number of both early and delayed complications of COVID-19. Β Π’ΡΠΆΠ΅Π»ΠΎΠ΅ ΡΠ΅ΡΠ΅Π½ΠΈΠ΅ Π½ΠΎΠ²ΠΎΠΉ ΠΊΠΎΡΠΎΠ½Π°Π²ΠΈΡΡΡΠ½ΠΎΠΉ ΠΈΠ½ΡΠ΅ΠΊΡΠΈΠΈ (COVID-19) ΡΠΎΠΏΡΡΠΆΠ΅Π½ΠΎ ΡΠΎ ΠΌΠ½ΠΎΠΆΠ΅ΡΡΠ²ΠΎΠΌ ΠΆΠΈΠ·Π½Π΅ΡΠ³ΡΠΎΠΆΠ°ΡΡΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ, ΠΊΠΎΡΠΎΡΡΠ΅ ΠΏΡΠΈΠ²ΠΎΠ΄ΡΡ ΠΊ ΠΎΡΡΡΠΎΡΠΊΠ΅ Π½Π°ΡΠ°Π»Π° Π°ΠΊΡΠΈΠ²Π½ΡΡ
ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΎΠ½Π½ΡΡ
ΠΌΠ΅ΡΠΎΠΏΡΠΈΡΡΠΈΠΉ ΠΈ ΡΡ
ΡΠ΄ΡΠ΅Π½ΠΈΡ Π΄ΠΎΠ»Π³ΠΎΡΡΠΎΡΠ½ΡΡ
ΡΠ΅Π·ΡΠ»ΡΡΠ°ΡΠΎΠ² Π»Π΅ΡΠ΅Π½ΠΈΡ. ΠΠ΄Π½ΠΈΠΌ ΠΈΠ· ΡΠ°ΠΊΠΈΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ ΡΠ²Π»ΡΠ΅ΡΡΡ ΡΠΎΡΠΌΠΈΡΠΎΠ²Π°Π½ΠΈΠ΅ ΡΡΠ°Ρ
Π΅ΠΎΠΏΠΈΡΠ΅Π²ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ²ΠΈΡΠ°. ΠΡΠΎΠ±Π΅Π½Π½ΠΎΡΡΡΡ ΡΡΠΎΠΉ ΠΏΠ°ΡΠΎΠ»ΠΎΠ³ΠΈΠΈ ΠΏΡΠΈ COVID-19 ΡΠ²Π»ΡΠ΅ΡΡΡ Π·Π°ΠΌΠ΅Π΄Π»Π΅Π½Π½Π°Ρ ΡΠ΅Π³Π΅Π½Π΅ΡΠ°ΡΠΈΡ ΡΠΊΠ°Π½Π΅ΠΉ, ΡΡΠΎ ΡΡΠ΅Π±ΡΠ΅Ρ Π½Π΅ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΠΎΠ³ΠΎ ΠΏΠΎΠ΄Ρ
ΠΎΠ΄Π° ΠΊ ΡΠ°ΠΊΡΠΈΠΊΠ΅ Π²Π΅Π΄Π΅Π½ΠΈΡ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ².Π ΡΡΠ°ΡΡΠ΅ ΠΏΡΠ΅Π΄ΡΡΠ°Π²Π»Π΅Π½ ΠΊΠ»ΠΈΠ½ΠΈΡΠ΅ΡΠΊΠΈΠΉ ΡΠ»ΡΡΠ°ΠΉ Π»Π΅ΡΠ΅Π½ΠΈΡ Π±Π΅ΡΠ΅ΠΌΠ΅Π½Π½ΠΎΠΉ ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΊΠΈ ΠΏΠΎΡΠ»Π΅ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½Π½ΠΎΠ³ΠΎ ΡΡΠΆΠ΅Π»ΠΎΠ³ΠΎ ΡΠ΅ΡΠ΅Π½ΠΈΡ COVID-19 Ρ ΡΠ°Π·Π²ΠΈΡΠΈΠ΅ΠΌ ΡΡΠ°Ρ
Π΅ΠΎΠΏΠΈΡΠ΅Π²ΠΎΠ΄Π½ΠΎΠ³ΠΎ ΡΠ²ΠΈΡΠ°, ΡΠ΅ΠΏΡΠΈΡΠ°, ΡΠΈΠ½Π΄ΡΠΎΠΌΠ° ΠΏΡΠΈΠΎΠ±ΡΠ΅ΡΠ΅Π½Π½ΠΎΠΉ Π² ΠΎΡΠ΄Π΅Π»Π΅Π½ΠΈΠΈ ΡΠ΅Π°Π½ΠΈΠΌΠ°ΡΠΈΠΈ ΠΈ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ»Π°Π±ΠΎΡΡΠΈ. ΠΠΎΠΌΠ±ΠΈΠ½Π°ΡΠΈΡ ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ Π·Π°Π±ΠΎΠ»Π΅Π²Π°Π½ΠΈΡ ΠΏΡΠΈΠ²Π΅Π»Π° ΠΊ Π·Π°ΡΡΠΆΠ½ΠΎΠΌΡ (ΠΎΠΊΠΎΠ»ΠΎ 5 ΠΌΠ΅Ρ.) ΠΏΠ΅ΡΠΈΠΎΠ΄Ρ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΠΈ.Π‘ΠΎΠ²ΡΠ΅ΠΌΠ΅Π½Π½ΡΠ΅ ΡΡΠ°Π½Π΄Π°ΡΡΠ½ΡΠ΅ ΠΊΠΎΠΌΠΏΠΎΠ½Π΅Π½ΡΡ ΠΈΠ½ΡΠ΅Π½ΡΠΈΠ²Π½ΠΎΠΉ ΡΠ΅ΡΠ°ΠΏΠΈΠΈ ΡΠ°ΠΊΠΈΡ
ΠΏΠ°ΡΠΈΠ΅Π½ΡΠΎΠ², Π²ΠΊΠ»ΡΡΠ°Ρ ΡΠ΅Π³ΡΠ»ΡΡΠ½ΡΠΉ ΠΊΠΎΠ½ΡΡΠΎΠ»Ρ Π΄Π°Π²Π»Π΅Π½ΠΈΡ Π² ΠΌΠ°Π½ΠΆΠ΅ΡΠ΅ ΡΠ½Π΄ΠΎΡΡΠ°Ρ
Π΅Π°Π»ΡΠ½ΡΡ
/ΡΡΠ°Ρ
Π΅ΠΎΡΡΠΎΠΌΠΈΡΠ΅ΡΠΊΠΈΡ
ΡΡΡΠ±ΠΎΠΊ, Π΄ΠΈΠ½Π°ΠΌΠΈΡΠ΅ΡΠΊΡΡ ΠΎΡΠ΅Π½ΠΊΡ Π½ΡΡΡΠΈΡΠΈΠ²Π½ΠΎΠ³ΠΎ ΡΡΠ°ΡΡΡΠ° ΠΈ Π΅Π³ΠΎ ΠΊΠΎΡΡΠ΅ΠΊΡΠΈΡ, ΡΠ°ΡΠΈΠΎΠ½Π°Π»ΡΠ½ΡΡ Π°Π½ΡΠΈΠΌΠΈΠΊΡΠΎΠ±Π½ΡΡ ΡΠ΅ΡΠ°ΠΏΠΈΡ, ΡΠΊΡΠΈΠ½ΠΈΠ½Π³ ΠΏΡΠΈΡ
ΠΈΡΠ΅ΡΠΊΠΈΡ
Π½Π°ΡΡΡΠ΅Π½ΠΈΠΉ ΠΈ ΡΠ°Π½Π½ΡΡ ΡΠ΅Π°Π±ΠΈΠ»ΠΈΡΠ°ΡΠΈΡ, ΠΏΠΎΠ·Π²ΠΎΠ»ΡΡ ΠΌΠΈΠ½ΠΈΠΌΠΈΠ·ΠΈΡΠΎΠ²Π°ΡΡ ΡΠΈΡΠ»ΠΎ ΠΊΠ°ΠΊ ΡΠ°Π½Π½ΠΈΡ
, ΡΠ°ΠΊ ΠΈ ΠΎΡΡΡΠΎΡΠ΅Π½Π½ΡΡ
ΠΎΡΠ»ΠΎΠΆΠ½Π΅Π½ΠΈΠΉ COVID-19
Inhaled surfactant in patients with covid-19 who took high-flow oxygen: the results of a retrospective analysis
The article presents a comparative retrospective analysis of clinical, laboratory data and outcomes in 39 patients with severe COVID-19 complicated by acute respiratory distress syndrome, who received high-flow oxygen therapy. Of which, 19 patients additionally received 75 mg of inhaled surfactant BL twice daily for 5 days using a nebulizer. As a result, mortality rate in the group of patients receiving surfactant was 10.5%, while in the standard therapy group β 50%; the number of patients transferred to the mechanical ventilation was 21% and 70%, respectively. As the patients receiving the surfactant were injected with COVID-19 hyperimmune convalescent plasma and monoclonal antibodies to interleukin-6 receptors more often than those from the control group, we recalculated the results regardless of these patients. However, a significant difference between the mechanical ventilation rate (2.5 times less often in the surfactant group) and mortality rate (3.5 times less in the surfactant group) was observed. The duration of hospitalization and stay at the intensive care unit was not significantly different between patients with and without surfactant treatment. Inhalation therapy with surfactant BL was well tolerated even by patients with chronic obstructive pulmonary disease. In no case did therapy have to be stopped due to side effects, the most common of which was coughing during inhalation. This retrospective analysis shows that the prescription of an inhaled surfactant prior to transferring patients to mechanical ventilation can prevent the progression of respiratory failure, put down mechanical ventilation, and improve survival
Coordinated Loss and Acquisition of NK Cell Surface Markers Accompanied by Generalized Cytokine Dysregulation in COVID-19
Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, is accompanied by a dysregulated immune response. In particular, NK cells, involved in the antiviral response, are affected by the infection. This study aimed to investigate circulating NK cells with a focus on their activation, depletion, changes in the surface expression of key receptors, and functional activity during COVID-19, among intensive care unit (ICU) patients, moderately ill patients, and convalescents (CCP). Our data confirmed that NK cell activation in patients with COVID-19 is accompanied by changes in circulating cytokines. The progression of COVID-19 was associated with a coordinated decrease in the proportion of NKG2D+ and CD16+ NK cells, and an increase in PD-1, which indicated their exhaustion. A higher content of NKG2D+ NK cells distinguished surviving patients from non-survivors in the ICU group. NK cell exhaustion in ICU patients was additionally confirmed by a strong negative correlation of PD-1 and natural cytotoxicity levels. In moderately ill patients and convalescents, correlations were found between the levels of CD57, NKG2C, and NKp30, which may indicate the formation of adaptive NK cells. A reduced NKp30 level was observed in patients with a lethal outcome. Altogether, the phenotypic changes in circulating NK cells of COVID-19 patients suggest that the intense activation of NK cells during SARS-CoV-2 infection, most likely induced by cytokines, is accompanied by NK cell exhaustion, the extent of which may be critical for the disease outcome
Coordinated Loss and Acquisition of NK Cell Surface Markers Accompanied by Generalized Cytokine Dysregulation in COVID-19
Coronavirus disease 2019 (COVID-19), caused by the SARS-CoV-2 virus, is accompanied by a dysregulated immune response. In particular, NK cells, involved in the antiviral response, are affected by the infection. This study aimed to investigate circulating NK cells with a focus on their activation, depletion, changes in the surface expression of key receptors, and functional activity during COVID-19, among intensive care unit (ICU) patients, moderately ill patients, and convalescents (CCP). Our data confirmed that NK cell activation in patients with COVID-19 is accompanied by changes in circulating cytokines. The progression of COVID-19 was associated with a coordinated decrease in the proportion of NKG2D+ and CD16+ NK cells, and an increase in PD-1, which indicated their exhaustion. A higher content of NKG2D+ NK cells distinguished surviving patients from non-survivors in the ICU group. NK cell exhaustion in ICU patients was additionally confirmed by a strong negative correlation of PD-1 and natural cytotoxicity levels. In moderately ill patients and convalescents, correlations were found between the levels of CD57, NKG2C, and NKp30, which may indicate the formation of adaptive NK cells. A reduced NKp30 level was observed in patients with a lethal outcome. Altogether, the phenotypic changes in circulating NK cells of COVID-19 patients suggest that the intense activation of NK cells during SARS-CoV-2 infection, most likely induced by cytokines, is accompanied by NK cell exhaustion, the extent of which may be critical for the disease outcome