Features of infusion therapy in therapeutic patients during the COVID-19 pandemic
Objective. To determine the features of infusion therapy (IT) in therapeutic patients with COVID-19.
Materials and methods. The publications were searched using PubMed and Google Scholar engines by such terms: COVID-19, infusion therapy, crystalloids, colloids. 68 publications were identified, which were published from December 2019 to August 15, 2020.
Results and discussion. Unfortunately, very few publications characterizing the features of IT in patients with COVID-19. The most complete recommendations are set out in the Surviving Sepsis Campaign: guidelines on the management of critically ill adults with COVID‑19. Indications for IT in COVID-19: hemodynamic instability, shock, heart disease and comorbidities (especially diabetes and cardiovascular disease). It is recommended not to use colloids, but buffered and balanced crystalloids for acute resuscitation of adults with COVID-19 and shock. In Ukraine, among balanced buffered crystalloids, the most popular and widespread solution is Rheosorbilact, which has a large number of positive reviews in domestic and foreign publications, including pneumonia and sepsis. Recommendations for the use of colloids: dextrans, gelatin and hydroxyethylated starches in COVID-19 are not recommended; albumin can be used for special indications (eg, severe hypoalbuminemia), but it is not recommended for routine and initial resuscitation; convalescent plasma transfusion appears to be a promising method that can provide passive immunity to SARS-CoV-2-specific antibodies, but is currently not recommended for routine use due to lack of evidence. It is proposed to use a conservative rather than a liberal strategy of fluid administration for the acute resuscitation of adults with COVID-19 and shock. In the meta-analysis of 11 randomized clinical trials (n=2051), it was shown that patients with severe acute respiratory syndrome or sepsis who received fluid according to a conservative strategy had more days without artificial ventilation and a shorter period of stay in the intensive care unit (ICU). At fever at patients with COVID-19 it is offered to use paracetamol. In severe cases, a solution of paracetamol (eg, Infulgan) can be administered intravenously at a dose of up to 4 g per day. Body temperature control does not reduce the risk of death, length of stay in ICU, but is effective for lowering associated symptoms (headache, dizziness, weakness), which is important to increase patient comfort.
Conclusions. In the treatment of patients with COVID-19 of great importance is the use of rational and balanced IT. The infusion program should be calculated not only in terms of hemodynamic effects, but also taking into account the quality of life and maximize patient comfort.
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