The aim. Determine hemodynamic status and its impact on oxygen transport, frequency of adverse events and outcomes in patients with severe SARS-CoV-2 associated with acute respiratory distress syndrome (ARDS). Materials and methods. A single-center prospective comparative study was conducted with 29 patients enrolled over the period of July—October 2020 who suffered a severe course of coronavirus disease and bilateral pneumonia associated with ARDS. Based on the estimated cardiac index (CI), patients were allocated to two groups: Group 1 included 14 patients with severe ARDS and CI 1.9 [1.5–2.5] L/min/m2, whereas Group 2 included 15 patients with CI 4.2 [3.2–8.1] L/min/m2 (p=0.001). Patient`s intensive care was regulated by the relevant orders of the Ministry of Health of Ukraine. Statistical analysis of the results was carried out using Statistica 10 software. Statistical significance of parameters was assessed using the non-parametric Wilcoxon criterion. Results were considered significant at p values <0.05. Data are presented as M [25–75]. Relative risk (RR) and odds ratio (OR) of adverse events were calculated. Results. The severe course of coronavirus disease is associated with significant oxygen transport disorders that increase with hypovolemia. Despite the increase in oxygen delivery in the group with normal CI its high tissue extraction remained, which may be a sign of development mitochondrial distress. Conclusions. Patients admitted to the ICU with severe COVID-19 may be in a state of hypovolemia and require individual assessment of hemodynamic status and the appointment of infusion therapy. Increased oxygen delivery in patients with normal cardiac index was associated with decreased adverse events rate and statistically significant decrease of mortality rate

The aim. Based on the study of the effect of invasive mechanical ventilation and NIV in the CPAP mode on the pathomorphosis of lung damage in patients with HRF caused by SARS-nCoV-2 and deaths in intensive care unit (ICU), determine the safest method of respiratory support. Materials and methods. The study included morphological material from 20 patients with HRF caused by SARS-nCoV-2 (COVID-19) who died in ICU. Group 1 included patients who received non-invasive lung ventilation in CPAP mode through a face mask (n=10), group 2 - patients who underwent invasive ventilation (n=10). The prepared sections, 5 μm thick, were stained according to the Van Gizon method. Photomicrographs were taken using Zeiss ZENliteimaging. Data are presented as M [25-75] and P±Sp. Statistical analysis of the results was performed using the program “Statistica 10”. Significance of differences in indicators was assessed using the nonparametric Wilcoxon test, the parametric Student's test. The results were considered reliable at values of p<0.05. Results The morphological structure of the lungs of patients of group 1 corresponded to the exudative phase of DAD with severe edematous-hemorrhagic syndrome, signs of interstitial pneumonia with desquamation of alveolocytes and the formation of hyaline membranes. In patients of group 2 in the lung tissue there was a picture of the proliferative phase of DAD with signs of interstitial pneumonia, and the development of focal fibrosing alveolitis. Thus, invasive mechanical ventilation, can accelerate the development of irreversible processes in the lungs in the form of fibrosing alveolitis and promote the formation of ventilator-associated pneumonia Conclusions. CPAP NIV is a promising method of respiratory support in patients with ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study

Background. The disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread around the world since December 2019 and has become a pandemic. Most patients have mild symptoms of COVID-19. However, about 5 % of individuals need intensive care due to the development of acute respiratory distress syndrome (ARDS), which may be accompanied by pulmonary hypertension. Today, the issues of intensive care for these conditions are unresolved and need further researches. The purpose was to study the state of the right heart, central hemodynamics and the effect of infusion of 4.2% L-arginine solution with 2% levocarnitine on them for the correction of pulmonary hypertension in patients with severe respiratory failure caused by COVID-19. Materials and methods. A single-center, prospective, non-comparative study was conducted in May-August 2020. It included 39 patients with severe SARS-CoV-2 (COVID-19), bilate­ral pneumonia, ARDS and pulmonary hypertension. The effect of the infusion of 4.2% L-arginine solution with 2% levocarnitine on the results of intensive care was analyzed. Results. The use of intravenous infusion of 100 ml of 4.2% L-arginine solution and 2% levocarnitine combined with standard treatment in accordance with the orders and protocols of the Ministry of Health of Ukraine has reduced pulmonary hypertension in patients with severe COVID-19 and ARDS. Conclusions. The use of a solution of 4.2% L-ar­ginine and 2% levocarnitine in patients with severe COVID-19 can be considered as a promising method for the treatment of right ventricular failure and pulmonary hypertension.

Hypoxemic respiratory failure (HRF) or acute respiratory distress syndrome is the most common and severe complication in patients with allow to maintain adequate oxygenation in patients with HRF, but it remains unclear which NIV regimen is more effective for reducing the need for invasive ventilation and improving outcomes. The aim. To compare the effect of different non-invasive lung ventilation strategies, namely CPAP+PSV and CPAP without PSV on the results of intensive care of patients with HRF caused by SARS-nCoV-2 (COVID-19). Materials and methods. A prospective single-center study of 59 patients with severe SARS-nCoV-2 (COVID-19) with HRF was performed. Depending on the type of NIV, patients were divided into two groups: in patients of group 1 (n=46) respiratory support was performed in CPAP mode without PSV, in patients of group 2 (n=13) -CPAP+PSV. All patients underwent clinical blood tests, biochemical studies aimed at assessing the severity of COVID-19, visualization of lung tissue (chest radiography, ultrasound to determine the profile of B and C), monitoring of gas exchange, echocardiography to assess the state of central hemodynamics. Statistical analysis of the results was performed using the program "Statistica 10". Estimated mean values, standard deviation. The relative risk (RR) of adverse events was assessed. Results. The use of CPAP without PSV improves the results of intensive care of patients with severe coronavirus disease with the development of HRF. Conclusions. CPAP NIV is a promising method of respiratory support in patients with moderate to severe ARDS caused by SARS-nCoV-2 virus (COVID-19), which needs further study

The aim of the study. To compare the effectiveness of methylprednisolone, dexamethasone and tocilizumab in patients with severe coronavirus disease. Identify the most appropriate treatment option. Materials and methods. Patients of group 1 (n=20) received for anti-inflammatory purposes tocilizumab at a dose of 600–800 mg. Patients in group 2 (n=82) received pulse therapy with methylprednisolone. Patients in group 3 (n=20) received dexamethasone 6 mg / day. Data are presented as M [25–75]. Statistical analysis of the results was performed using the program "Statistica 10". Significance of differences in indicators was assessed using the nonparametric Wilcoxon test. The results were considered reliable at values of p <0.05. Results. The severe course of coronavirus disease with the development of cytokine storm and respiratory distress syndrome is characterized by an increase in markers of inflammation: in group 1 the median CRP was 89.2 g / l, in group 2 – 64.2 g / l, and in 3 – 76.2 g / l, and did not differ significantly between groups (p> 0.05). The level of IL-6 in group 1 was 61.8 pg / ml, in group 2 – 64.6 pg / ml, and in group 3 – 46.5 pg / ml without significant differences between groups (p> 0.05). The level of ferritin in all groups exceeded normal values. Conclusions The most favourable result was obtained when using methylprednisolone: it was possible to reduce the mortality rate to 59.8 %. The relative risk of developing VTE was significantly higher in groups 1 and 3 (RR12 6.8 [2.7–16.8] p12 <0.0001, RR23 0.15 [0.06–0.35] p23 <0.0001), which gives grounds to confirm the presence of anticoagulant activity in methylprednisolone