ROLE OF EXTRACORPOREAL THERAPIES IN CRITICALLY ILL PATIENTS WITH SARS-COV-2
DOI:
https://doi.org/10.31379/2411.2616.17.1.1Keywords:
extracorporeal therapy, COVID-19, hemoperfusion, plasma separation, hemodiafiltration, chest MSCT, consolidation, ground-glass opacities.Abstract
Aim. To analyze the experience of using extracorporeal therapies to treat patients with SARS-CoV-2. Methods. 48 extracorporeal procedures were performed in 27 patients with a laboratory confirmed SARS-CoV-2, bilateral pneumonia, and various concomitant chronic diseases. All patients had the mean SOFA score of 8.1 ± 3.1 [min 3, max 16] at admission in the ICU. 19 patients (70.4%) had severe lung injury over 75% according to the chest CT scans. Indications for extracorporeal therapies initiation included cytokine storm associated with acute respiratory distress syndrome (ARDS) and septic shock. Results. Overall, each patient received at least one extracorporeal therapy. 11 patients underwent 2 to 6 sessions. Isolated plasma separation and hemoperfusion allowed reducing vasopressor / cardiotonic support, slightly improved ventilation parameters, with a significant, but not prolonged decrease in the levels of inflammation markers. The combination of methods that provide rapid elimination of agents, with prolonged correction of homeostasis and detoxification, with controlled temperature response and hydration, appeared to be the most rational. Extracorporeal therapy did not improve the volume and severity of damaged lung parenchyma. 19 (70.4%) patients who received extracorporeal therapy were transferred from mechanical ventilation to spontaneous breathing, whereas 8 (29.6%) patients had severe lung lesions over 75% according to the repeated chest CT scans. The mean length of stay in the ICU among survivors was 9 ± 3.5 [min 4 max 22]. The 28-day mortality and in-hospital mortality rate was 25.9% (7). Conclusion. Prolonged extracorporeal therapy in patients with SARSCov- 2 have demonstrated efficacy in relieving organ dysfunctions and shock states, but did not significantly improve the severity of damaged lung parenchyma.
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