The objective: to evaluate the effectiveness of inhaled surfactant therapy in the integrated treatment of severe COVID-19 pneumonia in a multicenter prospective clinical trial of surfactant-BL.Subjects and methods. 122 patients with severe COVID-19-associated pneumonia treated in two treatment centers were enrolled in the study. All of them received antiviral, anticoagulant and anti-inflammatory therapy. 56 patients also received inhalation therapy with surfactant-BL (OOO Biosurf, St. Petersburg, Russia) at a dose of 1 mg/kg 2-3 times a day. The remaining 66 patients received no surfactant-BL inhalation. When included into the study, all patients were divided into two groups based on severity of the condition at the time of inclusion: 62 people (Group I) needed oxygen inhalation through a face mask with the flow of 6-8 L/min for hypoxemia correction (27 received surfactant therapy and 35 did not); other 60 patients (Group II) required non-invasive respiratory support (constant positive airway pressure, non-invasive mechanical ventilation, high-flow oxygen therapy), of them 29 received surfactant therapy, while 31 patients did not.Results. In Group I, switching to invasive mechanical ventilation was required for 3/27 (11.1%) patients who received surfactant therapy, and 10/35 (28.6%) who received no surfactant therapy (p = 0.085); lethality made 3/27 (11.1%) and 9/35 (25.7%) (p = 0.131), respectively. In Group II, among those who received surfactant therapy, 5/29 (17.2%) were switched to invasive mechanical ventilation and 18/31 (58.1%) among those who did not receive it (p = 0.001); lethality made 5/29 (17.2%) and 18/31 (58.1%) (p = 0.001), respectively. In the pooled group of 122 patients with severe COVID-19-associated pneumonia, 8 (14.3%) of 56 patients who received surfactant died, and 27 (40.9%) of 66 died among those who did not receive it, (p = 0.001).Conclusion: Inhalation surfactant therapy can reduce the frequency of switching patients to mechanical ventilation and statistically significantly reduce lethality caused by severe pneumonia associated with SARS-CoV-2.
Amiodarone is a drug used in the treatment of life-threatening arrhythmias, which can lead to the development of amiodarone-induced thyrotoxicosis. In most cases this pathology can be treated by conservative methods; surgical treatment is resorted to in cases of thyrotoxicosis refractory to medical treatment. This case report describes surgical treatment of a patient with amiodarone-induced thyrotoxicosis, progressive heart failure, neurological pathology, bilateral pneumonia, functioning tracheostomy, systemic infectious process, multiple organ dysfunction syndrome, who was treated in the intensive care unit. Due to the lack of response to therapy with antithyroid drugs (thiamazole, lithium preparations and pulse therapy with prednisolone) and a progressive deterioration of the condition in a short period of time, according to vital indicators, the patient underwent thyroidectomy. In the postoperative period, there was a decrease in the occurrence of chronic heart failure symptoms. Medical control of cardiac arrhythmias was achieved. Surgical stage proceeded without complications in the period of 30-days. The patient was discharged for outpatient rehabilitation treatment.
Selective transcatheter thrombolysis (STT) in patients with pulmonary embolism (PE) with an intermediatehigh risk of 30-day mortality is an option for rapid lung reperfusion with a decrease in right ventricular (RV) afterload, which largely determines the prognosis of patients.Objective. Comparison of the efficacy of STT using reduced doses of alteplase and routine conservative treatment of patients with PE with an intermediate-high risk of 30-day mortality using a retrospective analysis of the data from Almazov National Medical Research Centre.Design and methods. The retrospective single-center study included 45 patients (18 men (40 %) and 27 women (60 %)) admitted to the anaesthesiology and resuscitation department of the Almazov National Medical Research Centre from January 1, 2021 to May 1, 2022 with the confirmed diagnosis of acute PE. Intermediate-high risk patients (22 people (57,9 %)) were divided into two groups according to the treatment strategy: the group receiving standard anticoagulant therapy (n = 15 (68,2 %)) and the group with STT by alteplase at a total dose of 50 mg (n = 7 (31,8 %)). In order to assess the effectiveness of treatment, the main laboratory and instrumental indicators were compared based on data from the medical information system.Results. Baseline clinical characteristics of the compared groups did not differ. Systolic pressure in the pulmonary artery (SPPA) in the transcatheter treatment group decreased from 59 [50; 82] to 35 [30; 65] mmHg; in the conservative treatment group: from 65 [50; 70] to 52 [40; 59] mmHg. In the selective thrombolysis group, there was a significant trend for a greater decrease SPPA compared to the anticoagulant therapy group: –25 [–29; –3] versus — 10 [–23; –6] mmHg, р = 0,047. There was a significant change in the level of leukocytes and platelets in the group of transcatheter treatment versus anticoagulant therapy: –5,0 [6,1; 4,1] × 109/l vs –2,8 [4,3; 1,8] × 109/l (p = 0,017) and 130 [32; 181] × 1012/l vs 31 [2; 56] × 1012/l (р = 0,044). There were no significant differences in the change in the RV size between the groups. The groups did not differ in the total number of hemorrhagic complications. When bleeding was divided by severity (according to the TIMI classification), moderate bleeding was more common in the selective thrombolysis group (2 cases versus 0 with a conservative approach, p = 0,014). There were no differences in the duration of treatment in the anaesthesiology and resuscitation department and the terms of inpatient treatment.Conclusions. A single center retrospective study demonstrated the high quality of approaches to the diagnosis and treatment of PE in terms of current guidelines. The STT with reduced doses of alteplase was associated with a more significant decrease SPPA and normalization of hemogram parameters when compared to the standard treatment approach. At the same time, selective thrombolysis was associated with a higher risk of hemorrhagic complications. A prospective study of the efficacy and safety of prolonged STT with the selection of the dose of thrombolytic in patients with PE with an intermediate-high risk of 30-day mortality is needed.
Pulmonary veno-occlusive disease (PVOD) is verified by identifying typical pathological changes in lungs or mutation in the EIF2AK4 gene. Clinical suspicion is based on combination of specific pulmonary pattern on computed tomography scan, hypoxemia with low diffusing lung capacity (DLCO) and inadequate response to specific therapy of pulmonary arterial hypertension (PAH). The rapid course of PVOD with high mortality determines the importance of early diagnosis and lung transplantation refferal.We present an unusual clinical case of 40-year-old woman with expected idiopathic PAH and extremely low DLCO with verified EIF2AK4 gene mutation, who demonstrated a positive vasoreactive test (VRT) and clinical response to calcium channel blockers therapy at the onset of the disease. The loss of positive VRT and subsequent PAH specific therapy escalation resulted in PVOD manifestation with severe desaturation, recurrent syncope and pulmonary edema. The combination of low DLCO and inadequate response to PAH therapy in idiopathic PAH patient should be of a paramount awareness of PVOD. Careful PAH therapy escalation with meticulous follow-up, pulmonary multispiral CT and genetic testing could improve early PVOD diagnostics and lung transplantation referral.
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