kpcczКомплексные проблемы сердечно-сосудистых заболеванийComplex Issues of Cardiovascular Diseases2306-12782587-9537Federal State Budgetary Institution “Research Institute for Complex Issues of Cardiovascular Diseases”10.17802/2306-1278-2022-11-2-72-83kpccz-1098Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯ. Анестезиология и реаниматологияORIGINAL STUDIES. Intensive careЭкстракорпоральные методы лечения в интенсивной терапии COVID-19: опыт одного центраExtracorporeal therapy in critically ill patients with COVID-19: a single-center experiencehttps://orcid.org/0000-0003-1791-9163РевишвилиА. Ш.RevishviliA. Sh.

Ревишвили Амиран Шотаевич, академик РАН, доктор медицинских наук, профессор, директор

ул. Большая Серпуховская, 27, Москва, 117997

Revishvili Amiran Sh., Academician of the Russian Academy of Sciences, Professor, Director

27, Bolshaya Serpuhovskaya St., Moscow, 117997

https://orcid.org/0000-0002-4291-3380ПлотниковГ. П.PlotnikovG. P.

Плотников Георгий Павлович, доктор медицинских наук, заведующий отделением анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Plotnikov Georgy P., MD, PhD, Head of the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

https://orcid.org/0000-0001-5527-7494РубцовМ. С.RubtsovM. S.

Рубцов Михаил Сергеевич, врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Rubtsov Mihail S., Intensivist at the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

https://orcid.org/0000-0002-7145-8516ГейзеА. В.GeyzeA. V.

Гейзе Антон Викторович, кандидат медицинских наук, врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Geyze Anton V., PhD, Intensivist at the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

antongeyze@mail.ruhttps://orcid.org/0000-0002-6542-8257ГалстянА. В.GalstyanA. V.

Галстян Андроник Варджанович, врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Galstyan Andronik V., Intensivist at the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

https://orcid.org/0000-0002-6149-189XКудрявцевА. Н.KudryavcevA. N.

Кудрявцев Антон Николаевич, врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Kudryavtsev Anton N., Intensivist at the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

https://orcid.org/0000-0002-0747-6445КлеузовичА. А.KleuzovichA. A.

Клеузович Артем Александрович, врач – анестезиолог-реаниматолог отделения анестезиологии-реанимации с палатами реанимации и интенсивной терапии

ул. Большая Серпуховская, 27, Москва, 117997

Kleuzovich Artem A., Intensivist at the Department of Anesthesiology and Intensive Care

27, Bolshaya Serpuhovskaya St., Moscow, 117997

Федеральное государственное бюджетное учреждение «Национальный медицинский исследовательский центр хирургии имени А.В. Вишневского» Министерства здравоохранения Российской ФедерацииРоссияFederal State Budgetary Institution “National Medical Research Center of Surgery named after A. Vishnevsky” of the Ministry of Healthcare of the Russian FederationRussian Federation2022140620221127283Copyright © Ревишвили А.Ш., Плотников Г.П., Рубцов М.С., Гейзе А.В., Галстян А.В., Кудрявцев А.Н., Клеузович А.А., 20222022Ревишвили А.Ш., Плотников Г.П., Рубцов М.С., Гейзе А.В., Галстян А.В., Кудрявцев А.Н., Клеузович А.А.Revishvili A.S., Plotnikov G.P., Rubtsov M.S., Geyze A.V., Galstyan A.V., Kudryavcev A.N., Kleuzovich A.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.nii-kpssz.com/jour/article/view/1098Основные положения

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

Цель. Анализ применения экстракорпоральных методов лечения (ЭМЛ) у пациентов с COVID-19.

Материалы и методы

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

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

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.

Highlights

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

Aim. To assess the safety and efficacy of extracorporeal therapy in patients with COVID-19.

Methods

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

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

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.

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The authors declare that there are no conflicts of interest present.