Microcirculatory hemodynamic indexes (HI) were assessed in patients with moderate and severe COVID-19. In both groups, a significant increase in the absolute spectral indexes (HI1, HI2, and HI3) and the ratio of low-frequency to high-frequency component (HI1/HI3) was revealed. In the group of severe infection, only the “slow” index (low-frequency HI1) of microcirculatory hemodynamics was significantly lower. The oscillatory indices MAYER1-3 and RESP1-3 were reduced in patients of both groups. The aggravation of the disease course was accompanied by depression of the low-frequency index HI1. Regulatory shifts compensate for disturbances in microcirculatory processes in moderate COVID-19, but severe course was associated with their decompensation.
Тяжелое течение COVID-19, сопровождаемое острой дыхательной недостаточностью, острым респираторным дистресс-синдром и полиорганной недостаточностью, наиболее часто наблюдается у пожилых (старше 65 лет), а также у сравнительно молодых пациентов с сопутствующими заболеваниями -сахарным диабетом, гипертонической болезнью, нарушениями сердечной, почечной или печеночной деятельности. При этом у больных возникает чрезмерная воспалительная реакция, которая сопровождается развитием «цитокинового шторма», разбалансированием и последующим истощением Т-клеточного иммунитета. Успешная терапия COVID-19 строится на восстановлении функций поврежденной иммунной системы, в том числе ликвидации «цитокинового шторма». С этой целью рекомендовано применение блокатора рецептора моноклонального антитела к IL6 (RIL6) тоцилизумаба (TCZ). Приведены сведения об успешном применении TCZ у больных тяжелой формой COVID-19, а также указаны его существенные недостатки -развитие неблагоприятных реакций -лимфоцитопении, тромбоцитопении, увеличения уровня IL6, аланин-и аспартатаминотрансферазы и др. Одновременно приведены обоснования для применения у таких больных иммуномодулятора тималина, способного ликвидировать «цитокиновый шторм», а также нормализовать состояние иммунной системы и предотвращать синдром диссеминированного внутрисосудистого свертывания. Приводятся типичные случаи лечения больных с тяжелыми формами COVID-19 при использовании на фоне стандартной терапии TCZ и тималина раздельно и совместно.
Background. Various methods of respiratory support in combination with prone positioning have been used during the COVID-19 pandemic. The effects of combination of these two factors on hemodynamics are of interest for clinical practitioners.The aim: to evaluate the effect of prone positioning on hemodynamics in COVID-19 patients depending on the method of respiratory support.Materials and methods. The study included 17 patients of both sexes diagnosed with COVID-19-associated community-acquired polysegmental viral and bacterial pneumonia with progressive respiratory failure. The study consisted of two stages. During the first stage, the patients were receiving respiratory support with humidified oxygen (3–7 liters per minute). The second stage was initiated after switching to noninvasive ventilation (NIV). The measurements were performed using a technique of volumetric compression oscillometry on a non-invasive hemodynamic monitoring system KAP CGosm-Globus (Russia).Results. The study showed that prone positioning in patients with severe COVID-19 when switching from oxygen therapy to NIV resulted in a change in the diastolic blood pressure difference module from 2.5 (1.0; 8.2) to 8.0 (5.7; 14.0) (p = 0.016). Escalation of respiratory support led to the changes in the left ventricular outflow tract velocity difference module from 11.5 (9.5; 34.2) to 31.0 (15.7; 42.0) (p = 0.049).Conclusions. Patients with community-acquired polysegmental viral and bacterial pneumonia associated with COVID-19 demonstrated changes in diastolic blood pressure and left ventricular outflow tract velocity as a result of prone positioning following switching from oxygen therapy to NIV.
Aim. To assess laboratory markers of hemodynamic status in patients with moderate to severe COVID-19.Materials and Methods. Here we examined 15 patients with moderate COVID-19 and 16 critically ill COVID-19 patients. The control group consisted of 20 healthy volunteers. The levels of endothelin-1, brain natriuretic peptide (BNP), and N-terminal pro-brain natriuretic peptide (NT-proBNP) were measured by enzyme-linked immunosorbent assay. The amounts of nitrites (NO2) and nitrates (NO3) were measured by a Griess test (an enzymatic conversion of nitrates to nitrites) with a following colorimetric analysis.Results. Measurements of endothelin-1, nitrites, and nitrates showed high variability. The levels of NT-proBNP were reduced by 65% and 50% in patients with moderate and severe COVID-19, respectively (p < 0.05). In contrast, the levels of BNP were elevated by 472% and 548% in these patient categories (p < 0.05). These results indicated increased left ventricular load and suggested a heart failure.Conclusion. Progressive increase of BNP and concurrent reduction of NT-proBNP indicate affected hemodynamics in patients with moderate and severe COVID-19.
Peptide drug Thymalin, isolated from the calve thymus, is successfully used for the treatment of various immunopathologies, including those in older age groups. The molecular mechanism of the Thymalin immunoprotective action is due to the effects of the short peptides KE, EW, EDP in its composition. These short peptides can specifically bind to double-stranded DNA and/or histone proteins and regulate gene expression, synthesis of immune system proteins, activity of gerontogenes, and stimulate stem cell differentiation. Regulation of immunogenesis is a key factor preventing the development of the “cytokine storm” that develops in severe COVID-19. The purpose of this work is to study the effectiveness of Thymalin in severe COVID-19 in older patients. Patients administered with Thymalin against the background of a standard therapy (
n
= 36) manifested a more rapid clinical improvement, higher proportions of recovery from lymphopenia, faster normalization of the concentration of C-reactive protein, D-dimer, the number of lymphocytes and NK-cells in the blood, compared to patients who received a standard therapy only (
n
= 44). Thymalin halved hospital mortality in older patients with severe COVID-19. The results obtained showed the effectiveness of Thymalin administration in the complex therapy of patients with severe COVID-19.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.