medalphabetМедицинский алфавитMedical alphabet2078-56312949-2807ООО «Альфмед»10.33667/2078-5631-2022-9-69-74medalphabet-2642Research ArticleСтатьиВлияние режима дозирования метилпреднизолона на развитие острого респираторного дистресс-синдрома у госпитализированных пациентов с COVID‑19Mode of methylprednisolone administration and its influence on ARDS dynamics in treatment of hospitalized COVID‑19 patientsГалкинаС. Н.GalkinaS. N.

Галкина Светлана Николаевна, заведующая 6-м инфекционным отделением

Москва

Galkina Svetlana N., head of the 6th Dept of Infectious Diseases

Moscow

galkinasn@list.ruРыбалкоА. С.RybalkoA. S.

Рыбалко Андрей Сергеевич, врач отделения реанимации и интенсивной терапии

Москва

Rybalko Andrey S., physician of Intensive Care Unit

Moscow

КарпунН. А.KarpunN. A.

Карпун Николай Александрович, д. м.н, зам. гл. врача по медицинской части; проф. кафедры анестезиологии и неотложной медицины

Москва

Karpun Nikolai A., DM Sci (habil.), deputy chief physician for Medical Affairs; professor at Dept of Anesthesiology and Emergency Medicine

Moscow

ЗолотоваЕ. А.ZolotovaE. A.

Золотова Елена Александровна, зав. 7-м инфекционным отделением, зам. гл. врача по инфекции

Москва

Zolotova Elena A., head of the 7th Dept of Infectious Diseases, deputy chief physician for infections

Moscow

ПереходовС. Н.PerekhodovS. N.

Переходов Сергей Николаевич, д. м.н, проф., гл. врач

Perekhodov Sergey N., DM Sci (habil.), professor, chief physician

Moscow

ЧаусН. И.ChausN. I.

Чаус Николай Иванович, к. м. н, зам. гл. врача по анестезиологии и реаниматологии; доцент кафедры анестезиологии и неотложной медицины

Москва

Chaus Nikolai I., PhD Med, deputy chief physician for anesthesiology and resuscitation; associate professor at Dept of Anesthesiology and Emergency Medicine

Moscow

БелобородовВ. Б.BeloborodovV. B.

Белобородов Владимир Борисович, д. м. н, проф., зав. кафедрой инфекционных болезней

Москва

Beloborodov Vladimir B., DM Sci (habil.), professor, head of Dept of Infectious Diseases

Moscow

ЕвдокимовЕ. А.EvdokimovE. A.

Евдокимов Евгений Александрович, д. м. н, проф., зав. кафедрой анестезиологии и неотложной медицины

Москва

Evdokimov Evgeny A., DM Sci (habil.), professor, head of Dept of Anesthesiology and Emergency Medicine

Moscow

ГБУЗ «Городская клиническая больница имени В. П. Демихова», МКЦИБ «Вороновское»РоссияCity Clinical Hospital n. a. V. P. Demikhov, Moscow Clinical Centre for Infectious Diseases VoronovskoyeRussian FederationГБУЗ «Городская клиническая больница имени В. П. Демихова», МКЦИБ «Вороновское»; ФГБОУ ДПО «Российская медицинская академия непрерывного медицинского образования» Минздрава РоссииРоссияCity Clinical Hospital n. a. V. P. Demikhov, Moscow Clinical Centre for Infectious Diseases Voronovskoye; Russian Medical Academy of Post-Graduate EducationRussian FederationГБУЗ «Городская клиническая больница имени В. П. Демихова», МКЦИБ «Вороновское»; ФГБОУ ДПО «Российская медицинская академия непрерывного медицинского образования» Минздрава РоссииРоссияCity Clinical Hospital n. a. V. P. Demikhov, Moscow Clinical Centre for Infectious Diseases Voronovskoye; Russian Medical Academy of Post-Graduate EducationRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного медицинского образования» Минздрава РоссииРоссияRussian Medical Academy of Post-Graduate EducationRussian Federation20220606202209Кардиология. Современная функциональная диагностика. Неотложная медицина (1)6974Copyright © Галкина С.Н., Рыбалко А.С., Карпун Н.А., Золотова Е.А., Переходов С.Н., Чаус Н.И., Белобородов В.Б., Евдокимов Е.А., 20222022Галкина С.Н., Рыбалко А.С., Карпун Н.А., Золотова Е.А., Переходов С.Н., Чаус Н.И., Белобородов В.Б., Евдокимов Е.А.Galkina S.N., Rybalko A.S., Karpun N.A., Zolotova E.A., Perekhodov S.N., Chaus N.I., Beloborodov V.B., Evdokimov E.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.med-alphabet.com/jour/article/view/2642Введение

Введение. Глюкокортикостериоды (ГКС) широко применяются по всему миру для контроля воспалительной реакции в терапии госпитализированных пациентов с COVID‑19. Тем не менее в научной литературе активно продолжаются дискуссии о наиболее корректном времени начала, длительности применения, режимах дозирования и методиках введения ГКС.

Целью настоящего ретроспективного анализа явилась оценка влияния режима дозирования ГКС на динамику развития ОРДС в терапии госпитализированных пациентов с COVID‑19.

Материалы и методы

Материалы и методы. Выполнен ретроспективный анализ динамики клинических показателей когорты пациентов (n = 61), получавших терапию метилпреднизолоном (МП) в двух разных режимах в инфекционном отделении нашего стационара. Применялись два режима дозирования МП с наибольшим объемом доказательной базы: введение в режиме пульс-терапии (группа 1) и болюсное введение ГКС с последующей непрерывной инфузией низких доз (группа 2). Применение МП начинали в инфекционном отделении на 3–4-е сутки после поступления в пациента стационар, то есть в первые 10 суток после проявления симптомов COVID‑19. Это более раннее начало применения ГКС, чем описано в большинстве опубликованных работ.

Результаты

Результаты. Положительная динамика на фоне терапии МП была более выражена в группе непрерывной инфузии. Перевод в ОРИТ потребовался 10 (33,3 %) пациентам 2-й группы и почти вдвое большему количеству пациентов 1-й группы – 19 (61,3 %) пациентам. Больные 1-й группы чаще нуждались в эскалации респираторной поддержки до искусственной вентиляции легких. Общая выживаемость на момент выписки из стационара составила 90,0 % во 2-й группе (группа непрерывной инфузии) и 77,5 % пациентов – в 1-й группе (группа пульсового дозирования).

Заключение

Заключение. По нашим наблюдениям, раннее применение МП (в течение 10 суток после проявления первых симптомов заболевания) в режиме «болюс с последующей непрерывной инфузией» в условиях инфекционного отделения может снизить тяжесть течения заболевания, потребность в эскалации респираторной поддержки, сократить количество случаев использования неинвазивной и инвазивной вентиляции легких и повысить выживаемость пациентов с COVID‑19. Эти результаты должны быть дополнительно изучены в рандомизированных контролируемых исследованиях.

Introduction

Introduction. Glucocorticoids are used worldwide to control hyperinflammation in hospitalized COVID‑19 patients. Nevertheless, the debate on the appropriate initiation time, effective treatment duration and modes of administration is still ongoing.

The aim of this retrospective group analysis was to evaluate the influence of early methylprednisolone (MP) administration mode on acute respiratory distress syndrome (ARDS) dynamics in patients with COVID‑19.

Materials and methods

Materials and methods. We performed a retrospective analysis of 61 patients, who received MP treatment in the infection unit of our institution. The patients were retrospectively grouped by the MP administration method: either pulse boluses (group 1), or initial loading bolus followed by continuous infusion (group 2). MP administration was initiated on day 3–4 after hospital admission, i. e., within the first 10 days of the manifestation of symptoms. This is an earlier corticoid administration start, than is being described in most publications.

Results

Results. The positive dynamics in the setting of MP therapy was more pronounced in the continuous infusion group. Intensive care unit (ICU) transfer was necessary for 10 patients (33.3 %) of group 2 and for almost twice as many (19 patients, 61.2 %) of group 1. Patients of group 1 required respiratory support escalation (to mechanical lung ventilation) more often. Overall survival at hospital discharge was 77.5 % in the bolus group (group 1) and 90.0 % in the continuous infusion group (group 2).

Conclusion

Conclusion. Based on our experience and the results of statistical analysis, the early use of MP (within 10 days of the first symptoms manifestation) in the ‘bolus followed by continuous infusion’ mode in the setting of the infection unit may reduce disease severity, decrease the need for respiratory support escalation, lower the number of cases of non-invasive and invasive lung ventilation and increase survival of COVID‑19 patients. These results must be further studied in randomized controlled studies.

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