Features of infusion therapy in patients of the therapeutic profile during the COVID-19 pandemic
Background. An analysis of 44,415 Chinese patients with COVID-19 found a critical condition defined as severe hypoxemia and/or other organ damage or shock in 2087 (5 %) (Wu Z. et al., 2020). In inpatients, the frequency of shock is likely to be higher and can reach 20-35 % (Yang X. et al., 2020). Risk factors for shock and unstable hemodynamics in COVID-19 are older age, the presence of comorbidities, lymphopenia, higher levels of D-dimer.
Objective. To describe the features of infusion therapy (IT) in patients of the therapeutic profile during the COVID-19 pandemic.
Materials and methods. Analysis of literature sources on this topic.
Results and discussion. The Surviving Sepsis guidelines state that crystalloids, not colloids, should be used for acute resuscitation of patients with COVID-19. The recommendation is based on indirect data on critically ill patients (Cochrane review by S.R. Lewis et al.). It is advisable to use buffered/balanced crystalloids. Such solutions include Reosorbilact (“Yuria-Pharm”), which has such effects as hemodynamic, detoxifying, microcirculatory, and diuretic. Reosorbilact corrects fluid-electrolyte and acid-base balance, improves the rheological properties of blood, reduces the need for sympathomimetics. The use of hydroxyethyl starch, gelatin and albumin in COVID-19 is not recommended. In the treatment of coronavirus pneumonia, IT is significantly limited due to the risk of fluid overload and the development of pulmonary edema. The use of conservative rather than liberal IT strategy is recommended, including for patients with acute respiratory distress syndrome (ARDS) who are on mechanical lung ventilation (MLV). In severe pneumonia, the use of vasopressors is recommended. Noradrenaline is used as a first-line vasoactive agent. The use of hyperosmolar solutions reduces the volume of infusion required to maintain stable hemodynamics in patients with severe sepsis. Hypertonic solutions also reduce the length of MLV in patients with shock. For adults with COVID-19 and refractory shock, low-dose corticosteroid therapy (bolus doses or infusion of prednisolone at a dose of 200 mg per day) has been suggested. Systemic corticosteroids should also be used in ARDS. In the absence of the latter, routine use of systemic corticosteroids is not recommended. Empirical use of antibacterial drugs is advisable in patients on ARDS, as superinfections in this group of patients are extremely common. The advantages of levofloxacin (Leflocin 750, “Yuria-Pharm”) include high efficiency against all respiratory pathogens, good penetration into the inflammatory focus, and active influence on microorganisms in biofilms. Leflocin 750 mg is administered once a day intravenously for 5-14 days. It is recommended to use paracetamol (Infulgan, “Yuria-Pharm”) to control fever. The advantages of the latter are lowering the temperature within 30 minutes after administration, antipyretic effect lasting up to 6 hours, safety for patients with gastrointestinal and hematological diseases. Infulgan is administered intravenously (1 g up to 4 times a day).
Conclusions. 1. Balanced IT holds a leading position in the treatment of severe coronavirus infection. 2. Preference should be given to balanced solutions of crystalloids. 3. The IT program should be designed taking into account the quality of life and creating maximum patient comfort.
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