Экстракорпоральные методы лечения в интенсивной терапии COVID-19: опыт одного центра

Highlights. Plasma separation and cytokine hemoperfusion effectively stop cytokine shock, but prolonged extracorporeal therapy in patients with COVID-19 has demonstrated effectiveness in reducing organ dysfunction without significantly affecting extent of lung parenchyma damage.Aim. To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19.Methods. The study included 27 patients aged 67±9.7 [min 38, max 87] years with a laboratory-confirmed SARS-CoV-2 and bilateral polysegmental pneumonia, various concomitant chronic diseases who were admitted to Intensive Care Unit and received extracorporeal therapies. All patients had the mean NEWS score of 6.9±2.7 [min 4, max 9] and the mean SOFA score of 8.1±3.1 [min 3, max 16] at admission to the ICU. 19 patients (70.4%) had severe lung lesions over 75% according to the chest CT scans. 48 extracorporeal therapies were performed using the Multifiltrate (Fresenius Medical Care, Germany) and Aquarius (Nikkiso Aquarius RCA, Great Britain) medical devices. Indications for extracorporeal therapy initiation included cytokine storm associated with acute respiratory distress syndrome and septic shock.Results. Generally, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion helped to reduce vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not long-term decrease in the levels of inflammation markers. Combining different modalities of extracorporeal therapy that provide rapid elimination of agents, controlled temperature response and hydration, maintaining homeostasis and detoxification, appeared to be most optimal. Extracorporeal therapy did not improve the volume of lung parenchyma or lung parenchyma damage. However, 19 (70.4%) patients who received extracorporeal therapy transitioned from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions (over 75%) according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9±3.5 [min 4, max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7).Conclusion. Prolonged extracorporeal therapy in patients with SARS-Cov-2 has demonstrated efficacy in relieving organ dysfunctions and shock states, but did not significantly affect the remaining lung parenchyma damage.Основные положения. Плазмосепарация и цитокиновая гемоперфузия эффективно купируют цитокиновый шок, но продленная экстракорпоральная терапия у пациентов с СOVID-19 продемонстрировала большую эффективность в снижении органных дисфункций без значимого влияния на степень повреждения паренхимы легких.Цель. Анализ применения экстракорпоральных методов лечения (ЭМЛ) у пациентов с COVID-19.Материалы и методы. ЭМЛ использованы у 27 пациентов в возрасте 67±9,7 [min 38, max 87] лет с подтвержденным диагнозом COVID-19, двухсторонней полисегментарной пневмонией и различными сопутствующими хроническими заболеваниями. Тяжесть состояния при поступлении по шкале NEWS – 6,9±2,7 [min 4, max 9] балла, в отделении реанимации и интенсивной терапии по шкале SOFA – 8,1±3,1 [min 3, max 16] балла. У 19 (70,4%) больных диагностирована степень тяжести поражения легких на уровне КТ-4. Проведено 48 процедур ЭМЛ на гемопроцессорах «Мультифильтрат» (Fresenius Medical Care, Германия) и «Аквариус» (Nikkiso Aquarius RCA, Великобритания). Показаниями к инициации ЭМЛ были шоковые состояния – цитокиновый шторм с острым респираторным дистресс-синдромом и септический шок.Результаты. В основном экстракорпоральная терапия включала одну процедуру, 11 пациентам требовалось от 2 до 6 сеансов. Изолированные плазмосепарация и гемоперфузия обеспечивали снижение дозы вазопрессорной/кардиотонической поддержки, несколько улучшали вентиляционные показатели со значимым, но непродолжительным снижением концентрации маркеров воспаления. Комбинация методов, обеспечивающих быструю элиминацию агентов, включая продленную коррекцию гомеостаза и детоксикацию, контролируемую температурную реакцию и гидратацию, оказалась наиболее рациональной. Показано отсутствие влияния ЭМЛ на объем и степень повреждения паренхимы легких. Тем не менее 19 (70,4%) больных с ЭМЛ переведены с искусственной вентиляции легких на самостоятельное дыхание, при этом у 8 (29,6%) по данным контрольного мультиспирального КТ-исследования оставалась степень поражения КТ-4. Средняя длительность нахождения в отделении реанимации и интенсивной терапии выживших пациентов, получавших ЭМЛ, – 9±3,5 [min 4, max 22] сут; 28-дневная и госпитальная летальность – 7 (25,9%) случаев.Заключение. Продленные методы экстракорпорального лечения пациентов с COVID-19 продемонстрировали эффективность в купировании органных дисфункций и шоковых состояний, но не оказывали значимого влияния на степень повреждения паренхимы легких

Empagliflozin in patients hospitalized for acute decompensated heart failure: an expert resolution on the discussion of the EMPULSE trial

An online expert meeting held on November 17, 2021 reviewed the results of the randomized, double-blind, multinational, parallel-group EMPULSE trial, evaluating the clinical benefit and safety of the sodium-glucose co-transporter-2 inhibitor (SGLT2i) empagliflozin compared with placebo in patients hospitalized with acute decompensated heart failure (ADHF). Patients were included in the study regardless of ejection fraction (EF) and the presence of diabetes and randomized during hospitalization after stabilization. In addition, the EMPULSE trial used a composite result analyzed using a stratified benefit ratio — Win Ratio analysis. There is evidence of clinical benefit of empagliflozin in hospitalized patients with preserved and reduced LVEF, as well as in patients with newly diagnosed ADHF or with acute decompensation of chronic heart failure (CHF) compared with placebo, regardless of type 2 diabetes presence. The importance of the favorable results of the EMPULSE trial and its significance for clinical practice, which implies the early administration of empagliflozin for inpatients, is noted. A number of proposals have been adopted to accelerate the introduction of empagliflozin into clinical practice for patients with ADHF

Glycemia control and choice of antihyperglycemic therapy in patients with type 2 diabetes mellitus and COVID-19: a consensus decision of the board of experts of the Russian association of endocrinologists

A dangerous viral disease COVID-19, caused by a new RNA coronavirus SARS-COV-2, has been actively spreading in the world since December 2019. The main manifestations of this disease are bilateral pneumonia, often accompanied by the development of acute respiratory syndrome and respiratory failure. Patients with diabetes mellitus (DM) are at high risk of infection with the SARS-COV-2 virus, severe illness and death.Maintaining of target glycemic levels is the most important factor in a favorable outcome of COVID-19 in both type 1 and type 2 DM. The choice of antihyperglycemic therapy in a patient with DM in the acute period of COVID-19 depends on the initial therapy, the severity of hyperglycemia, the severity of the viral infection and the patient’s clinical condition.The article presents the recommendations of the board of experts of the Russian Association of Endocrinologists on glycemic control and the choice of antihyperglycemic therapy in patients with type 2 DM and COVID-19, and also on the use of glucocorticosteroids used in the treatment of COVID-19 in patients with type 2 DM

Rehabilitation after COVID-19. Resolution of the International Expert Council of the Eurasian Association of Therapists and the Russian Society of Cardiology

By the middle of 2021, the official global number of coronavirus disease 2019 (COVID-19) patients was close to 230 million, but the number accounting for asymptomatic patients was much higher. Consequences and rehabilitation after COVID-19 are of particular interest and raise many controversial and unresolved issues. On May 18, 2021, the Eurasian Association of Therapists organized an international panel of experts to analyze challenges associated with the post-COVID-19 period. This panel aimed to develop approaches to identify gaps in the discussed issues. This interdisciplinary team of leading experts reviewed the current literature and presented their data to formulate practical guidance on management of patients after COVID-19. The panel of experts also presented recommendations on how to implement the gained knowledge into health care practices

Diabetes mellitus type 2 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidelines.&nbsp

Diabetes mellitus type 1 in adults

Public organization “Russian Association of Endocrinologists”. Clinical guidlines