Guidelines for the diagnosis and treatment of circulatory diseases in the context of the COVID-19 pandemic

The objective: to evaluate the effectiveness of inhaled surfactant therapy in the integrated treatment of severe COVID-19 pneumonia in a multicenter prospective clinical trial of surfactant-BL.Subjects and methods. 122 patients with severe COVID-19-associated pneumonia treated in two treatment centers were enrolled in the study. All of them received antiviral, anticoagulant and anti-inflammatory therapy. 56 patients also received inhalation therapy with surfactant-BL (OOO Biosurf, St. Petersburg, Russia) at a dose of 1 mg/kg 2-3 times a day. The remaining 66 patients received no surfactant-BL inhalation. When included into the study, all patients were divided into two groups based on severity of the condition at the time of inclusion: 62 people (Group I) needed oxygen inhalation through a face mask with the flow of 6-8 L/min for hypoxemia correction (27 received surfactant therapy and 35 did not); other 60 patients (Group II) required non-invasive respiratory support (constant positive airway pressure, non-invasive mechanical ventilation, high-flow oxygen therapy), of them 29 received surfactant therapy, while 31 patients did not.Results. In Group I, switching to invasive mechanical ventilation was required for 3/27 (11.1%) patients who received surfactant therapy, and 10/35 (28.6%) who received no surfactant therapy (p = 0.085); lethality made 3/27 (11.1%) and 9/35 (25.7%) (p = 0.131), respectively. In Group II, among those who received surfactant therapy, 5/29 (17.2%) were switched to invasive mechanical ventilation and 18/31 (58.1%) among those who did not receive it (p = 0.001); lethality made 5/29 (17.2%) and 18/31 (58.1%) (p = 0.001), respectively. In the pooled group of 122 patients with severe COVID-19-associated pneumonia, 8 (14.3%) of 56 patients who received surfactant died, and 27 (40.9%) of 66 died among those who did not receive it, (p = 0.001).Conclusion: Inhalation surfactant therapy can reduce the frequency of switching patients to mechanical ventilation and statistically significantly reduce lethality caused by severe pneumonia associated with SARS-CoV-2.

Cardiogenic shock is a syndrome of critical hypoperfusion associated with a fatal decrease in myocardial contractile activity. Phenotypically cardiogenic shock is most frequently based on acute coronary syndrome, less often — on postcardiotomy cardiogenic shock and shock due to sepsis. Despite successes in the development of intensive care methods, cardiogenic shock is still accompanied by high mortality. Updating the data on the diagnosis and intensive care of this condition is a necessary condition for improving the quality of medical care. The present work describes modern definitions and ideas about the pathogenesis of cardiogenic shock, as well as the phase concept of intensive care, the role of endovascular revascularization and methods of mechanical circulatory support. The review is emphasized on cardiogenic shock in acute coronary syndrome.

Arterial hypertension is the most common and socially significant disease among the adult population, which is associated with the development of cardiovascular and other complications during non-cardiac surgery. In 2020, the all-Russian public organization Federation of Anesthesiologists and Intensive Care Specialists developed recommendations for the perioperative management of patients with concomitant hypertension, which have no analogues in the world literature. In the second edition, from the standpoint of evidence-based medicine, the section of preoperative assessment was expanded by substantiating functional tests and instruments for stratification of cardiac risk, the tactics of antihypertensive therapy in the perioperative period were clarified, safe target thresholds of blood pressure during anesthesia were reasoned, including the variability and duration of this indicator. The recommendations are intended for anesthesiologists and intensive care specialists, but they will also be useful for students, clinical residents, graduate students and doctors of all surgical specialties.

Pharmacological scores, such as inotropic score (IS) and vasoactive-inotropic score (VIS) were created to quantify doses of vasoactive and inotropic drugs. The number of studies where IS and VIS were used for evaluation of postoperative period of adult patients after cardiac surgery is small. Objective: to estimate IS and VIS as an approach for monitoring of the hemodynamic profile and clinical outcomes in the early postoperative period of cardiac surgery. Methods. The study involved 144 patients older than 18 years who underwent cardiac surgery under cardiopulmonary bypass (CPB). In perioperative period we measured cardiac output using a Swan-Ganz catheter with the calculation of central hemodynamic parameters, and also VIS and IS wcre calculated. We evaluated the prognostic value of these pharmacological scores in the development of complications of the early postoperative period, as well as their correlation with the duration of respiratory support, the length of stay in the ICU, and total hospital time. Results. IS ≥ 10 significantly associated with prolonged respiratory support, a long stay in the ICU and with a mortality rate of 28.6 %. Patients with IS ≥ 10 are characterized by a violation of tissue perfusion, main cause of which may be a low cardiac output syndrome. IS ≥ 10 can be used as criteria for the low cardiac output syndrome with impaired organ perfusion. The use of this pharmacological score as a predictor of adverse clinical outcomes and increased mortality is justified. The hemodynamic profile of patients with VIS ≥ 10 is characterized by the absence of signs of cardiac output decrease and normal organ perfusion. It has low prognostic significance for the adverse postoperative clinical outcomes and should not be used as perioperative criteria for low cardiac output. In addition, VIS ≥ 10 requires careful use as a predictor of adverse postoperative outcomes and mortality.