Current conception about the pathogenesis and intensive care of severe COVID-19 (review)

Authors

DOI:

https://doi.org/10.15587/2519-4798.2021.241456

Keywords:

COVID-19, SARS-CoV-2, acute respiratory failure, acute respiratory distress syndrome, respiratory therapy, corticosteroid therapy

Abstract

The aim of the research. The aim of this work was to summarize the scientific literature data on the pathogenesis and intensive care of the severe course of coronavirus infection.

Materials and methods. Databases such as PubMed, Google Scholar, Scopus and Web Of Science 2020-2021 were used for literary searches.

Results. An intense inflammatory response against the SARS-CoV-2 virus in COVID-19 patients causes a cytokine storm and hypercoagulability with the development of acute respiratory distress syndrome (ARDS) and multiple organ failure. Approximately 17 % to 35 % of hospitalized patients with COVID-19 are treated in the intensive care unit, most often due to hypoxemic respiratory failure and the development of ARDS, and between 29 % and 91 % of patients in intensive care units require invasive ventilation.

In addition to acute respiratory failure, hospitalized patients may have acute renal failure (9 %), liver dysfunction (19 %), coagulation disorders (10 %–25 %), and septic shock (6 %).

More than 75 % of hospitalized patients require additional oxygen therapy. Respiratory support could vary from the need for oxygen supplementation through a nasal catheter to invasive ventilation or extracorporeal membrane oxygenation in patients with the most severe ARDS.

The uncontrolled inflammation and coagulation seen in COVID-19 patients is similar to multifactorial ARDS, where a plethora of evidence has demonstrated the ability of long-term corticosteroid therapy (CST) to reduce inflammation-coagulation-fibroproliferation and accelerate recovery.

With regard to the assessment of the benefits of therapeutic anticoagulation in patients with elevated D-dimer, the question has not yet been finally resolved, and research devoted to this is still ongoing.

Conclusions. The approaches to respiratory, anticoagulant, anti-inflammatory therapy in critically ill patients with COVID-19 require further research to determine the optimal treatment tactics

Author Biographies

Marine Georgiyants, Kharkiv Medical academy of Postgraduate Education

Doctor of Medical Sciences, Professor, Vice-Rector

Department of Anesthesiology, Pediatric Anesthesiology and Intensive Care

Volodymyr Korsunov, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Sciences, Professor

Department of Anesthesiology, Pediatric Anesthesiology and Intensive Care

Sergii Dubrov, Bogomolets National Medical University

Doctor of Medical Sciences, Professor, Head of Department

Department of Anesthesiology and Intensive Care

Oleg Loskutov, Shupyk National Healthcare University of Ukraine

Doctor of Medical Sciences, Professor

Department of "Anesthesiology and Intensive Care"

Nataliia Bohuslavska, Kharkiv Medical Academy of Postgraduate Education

PhD, Associate Professor

Department of Anesthesiology, Pediatric Anesthesiology and Intensive Care

Vadim Nikonov, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Sciences, Professor

Department of Emergency Medicine and Disaster Medicine

Lidiya Cherkashyna, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Sciences, professor

Department of Family Medicine, Folk and Alternative Medicine and Sanology

Oleksiy Oparin, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Sciences, Professor

Department of Therapy, Rheumatology and Clinical Pharmacology

Pavel Nartov, Kharkiv Medical Academy of Postgraduate Education

Doctor of Medical Sciences, Professor

Department of Infectious Diseases

Maksym Holianishchev, Kharkiv Medical Academy of Postgraduate Education

PhD, Associate Professor

Department of Anesthesiology and Intensive Care

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2021-09-30

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Georgiyants, M., Korsunov, V., Dubrov, S., Loskutov, O., Bohuslavska, N., Nikonov, V., Cherkashyna, L., Oparin, O., Nartov, P., & Holianishchev, M. (2021). Current conception about the pathogenesis and intensive care of severe COVID-19 (review). ScienceRise: Medical Science, (5(44), 4–9. https://doi.org/10.15587/2519-4798.2021.241456

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Medical Science