rmtОбщая реаниматологияGeneral Reanimatology1813-97792411-7110FSBI "SRIGR" RAMS10.15360/1813-9779-2022-5-10-17rmt-2270Research ArticleКЛИНИЧЕСКИЕ ИССЛЕДОВАНИЯCLINICAL STUDIESГемосорбция у пациентов с различными видами респираторной поддержки при тяжелом течении COVID-19Hemoadsorption in Patients with Various Types of Respiratory Support for Severe COVID-19ЯкубцевичР. Э.YakubtsevichR. E.

230009, Гродно, ул. Горького, д. 80

Ruslan E. Yakubtsevich

80 Gorky Str., 230009 Grodno

РакашевичД. Н.RakashevichD. N.

Дмитрий Николаевич Ракашевич

230009, Гродно, ул. Горького, д. 80

Dmitry N. Rakashevich

80 Gorky Str., 230009 Grodno

wwwrakashevichdima2011@mail.ruГродненский государственный медицинский университетБеларусьGrodno State Medical UniversityBelarus2022241020221851017Copyright © Якубцевич Р.Э., Ракашевич Д.Н., 20222022Якубцевич Р.Э., Ракашевич Д.Н.Yakubtsevich R.E., Rakashevich D.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.reanimatology.com/rmt/article/view/2270Цель исследования

Цель исследования. Оценить эффективность гемосорбции у пациентов с тяжелым течением COVID-19 при проведении инвазивной искусственной вентиляции легких (ИВЛ) и неинвазивной респираторной поддержки.

Методы

Методы. Ретроспективно продольно изучили клинико-лабораторные показатели 49 пациентов с тяжелым течением коронавирусной инфекции, находившихся на лечении в ОАиР №1 Гродненской университетской клиники в период с сентября 2020 года по ноябрь 2021 года, при проведении гемосорбции через сорбент «Гемо-Протеазосорб». Всех пациентов разделили на две группы: «Гемо-Протеазосорб + ИВЛ» (n=22) — гемосорбцию проводили на фоне инвазивной ИВЛ, и «Гемо-Протеазосорб без ИВЛ» (n=27) — гемосорбцию проводили на фоне низко- и высокопоточной оксигенотерапии, либо неинвазивной ИВЛ (НИВЛ).

Результаты

Результаты. На фоне гемосорбции в группе «Гемо-Протеазосорб + ИВЛ» отметили снижение прокальцитонина (РСТ) (0,27  (0,12–2,08)  —  0,14  (0,05–1,77)), при р=0,027, С-реактивного белка (СРБ) (135,4 (10,6–303,0) — 64,3 (1,2–147,0)), при р=0,003, фибриногена (11,7 (4,9–19,49) — 8,2 (3,7–14,7)), при р=0,00004, Д-димеров (1432,0 (443,0–6390,0) — 1087,0 (415,0–3247,0)), при р=0,006 на 3-и сутки после сеанса ЭКД. В группе «Гемо-Протеазосорб без ИВЛ» также отметили снижение РСТ (0,29 (0,14–21,25) — 0,14 (0,04–11,91)), при р=0,002, СРБ (132,6 (30,7–183,0) — 28,55 (5,3–182,0)), при р=0,0002, фибриногена (10,2 (4,41–15,5) — 6,5 (2,8–11,9)), при р=0,00005, Д-димеров 1445,0 (365,0–4830,0)) — 1049,0 (301,0–3302,0)), при р=0,005, наблюдали повышение индекса SpO₂/FiO₂ (238 (88–461) — 320 (98–471)), при р=0,011. На 5-7-е сутки в группе «Гемо-Протеазосорб без ИВЛ» наблюдали положительную динамику индекса SpO₂/FiO₂ (238 (88–461) — 320 (96–471)), при р=0,002, а также — тенденцию к дальнейшему снижению СРБ (132,6  (30,7–183,0)  —  23,85  (2,2–200,0)), при р=0,0001 и фибриногена (10,2  (4,41–15,5)  —  5,11 (2,3–11,5)), при р=0,0017. Состояния пациентов на фоне гемосорбции на всех этапах исследования оценивали по шкале NEWS2. В группе «Гемо-Протеазосорб + ИВЛ» отметили уменьшение среднего балла на 2–3-и сутки исследования (8,0 (4,0–11,0) — 6,0 (2,0–10,0)), при р=0,0002, на 5–7-е сутки отметили его рост по сравнению со 2 этапом, но значения были ниже чем на этапе «до гемосорбции» (8,0 (4,0–11,0) — 7,0 (2,0–9,0)), при р=0,011. В группе «Гемо-Протеазосорб без ИВЛ» на 3-и сутки лечения отметили уменьшение среднего балла по шкале NEWS2 (7,0 (3,0–9,0) — 5,0 (1,0–9,0)), при р=0,00002, на 5–7-е сутки тенденция к его снижению сохранялась (7,0 (3,0–9,0) — 3,0 (1,0–8,0)), при р=0,00002.

Заключение

Заключение. У пациентов с тяжелым течением COVID-19 при проведении как кислородотерапии, так и искусственной вентиляции легких (ИВЛ) эффективна гемосорбция ввиду снижения уровней маркеров воспаления, гиперкоагуляции, уменьшения баллов по шкале NEWS2.

Study aim

Study aim. To evaluate the efficacy of hemoadsorption in patients with severe COVID-19 on mechanical lung ventilation (MLV) and noninvasive respiratory support.

Material and methods

Material and methods. We retrospectively analysed longitudinal clinical and laboratory parameters of 49 patients with severe coronavirus infection who were treated in the First Intensive care unit of Grodno University Hospital from September 2020 to November 2021 and underwent hemoadsorption using the Hemo-Proteasosorb sorbent. All patients were divided into two groups: Hemo-Proteasosorb + MLV (22 patients who underwent hemoadsorption while being on MLV) and Hemo-Proteasosorb without MLV (27 patients who had hemoadsorption while receiving the low- and high-flow oxygen therapy or noninvasive lung ventilation).

Results

Results. In the Hemo-Proteasosorb + MLV group a decrease in procalcitonin (PCT) (from 0.27 [0.12–2.08] down to 0.14 [0.05–1.77], P=0.027), C-reactive protein (CRP) (from 135.4 [10.6–303.0] down to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7  [4.9–19.49] to 8.2  [3.7–14.7], P=0.00004), and D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) was seen on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also demonstrated a reduction in the levels of CRP (from 4 [10.6–303.0] to 64.3 [1.2–147.0], P=0.003), fibrinogen (from 11.7 [4.9–19.49] to 8.2 [3.7–14.7], P=0.00004), D-dimer (from 1432.0 [443.0–6390.0] to 1087.0 [415.0–3247.0], P=0.006) on day 3 after the hemoadsorption session. The Hemo-Proteasosorb without MLV group also showed a decrease in PCT (from 0.29 [0.14–21.25] to 0.14 [0.04–11.91], P=0.002), CRP (from 132.6 [30.7–183.0] to 28.55 [5.3–182.0], P=0.0002), fibrinogen (from 10.2 [4.41–15.5] to 6.5 [2.8–11.9], P=0.00005), D-dimer (from 1445.0 [365.0–4830.0] to 1049.0 [301.0–3302.0], P=0.005), while an increase in SpO₂/FiO₂ (from 238 [88–461] up to 320 [98–471], P=0.011) was registered. On days 5–7, positive changes in SpO₂/FiO₂ index (238 [88–461] vs 320 [96–471], P=0.0020) were observed in the Hemo-Proteasosorb without MLV group, as well as a trend toward further reduction in the levels of CRP (132.6 [30.7–183.0] vs 23.85 [2.2–200.0], P=0.0001) and fibrinogen (10.2 [4.41–15.5] to 5.11 [2.3–11.5], P=0.0017). The patients were assessed using the NEWS2 score at all the stages of the study. On days 2–3 of the study, a reduction in the mean NEWS2 score was noted in the Hemo-Proteasosorb + MLV group (8.0  [4.0–11.0] vs 6.0 [2.0–10.0], P=0.0002), whereas on days 5–7 its increase was seen vs stage 2 of the study with its values still lower than those prior to hemoadsorption (8.0 [4.0–11.0] vs 7.0 [2.0–9.0], P=0.011). On day 3 of treatment, in the Haemo-Proteasorb without MLV group we observed a decreased mean NEWS2 score (7.0 [3.0–9.0] vs 5.0 [1.0–9.0], P=0.00002), on days 5–7, this trend was still present (7.0 [3.0–9.0] vs 3.0 [1.0–8.0], P=0.00002).

Conclusion

Conclusion. Hemoadsorption was beneficial for patients with severe COVID-19 during both oxygen therapy and mechanical ventilation due to decreased levels of inflammatory markers, hypercoagulation, and reduced NEWS2 scores.

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