COVID-19: Opportunities to Improve Prognosis

• Published in: Herald of the Russian Academy of Sciences Vol. 92; no. 4; pp. 404 - 411
• Main Author: Avdeev, S. N.
• Format: Journal Article
• Language: English
• Published: Moscow Pleiades Publishing 2022; Springer Nature B.V
• Subjects: Chemistry/Food Science; Chemotherapy; Coronaviruses; COVID-19; Earth and Environmental Science; Earth Sciences; Engineering; Environment; Glucocorticoids; Life Sciences; Mortality; Pandemics; Patient positioning; Prognosis; Scientific Session of the General Meeting of the RAS Members “The Role of Science in Overcoming Pandemics and Postcrisis Development of Society”; Social Sciences; Ventilation; Ventilators; COVID-19; prone position; iloprost; prostacyclin; noninvasive ventilation; prognosis; surfactant; N-acetylcysteine
• ISSN: 1019-3316; 1555-6492
• DOI: 10.1134/S1019331622040025

COVID-19 is characterized by a severe course in approximately 5‒10% of patients, who require admittance to the intensive care unit and mechanical ventilation, which is associated with a very high risk of a poor prognosis. At present, in real clinical practice, in managing severe patients with COVID-19, noninvasive ventilation (NIV) is widely used (in some countries, up to 60% of all methods of respiratory support). In most studies on the effectiveness of NIV in hypoxemic acute respiratory failure in patients with COVID-19, the need for tracheal intubation and hospital mortality with the use of NIV averaged 20–30%, which suggests the rather high efficiency of this method. The COVID-19 pandemic has given a powerful impetus to the widespread use of prone positioning among nonintubated patients with acute respiratory failure caused by COVID-19. Several studies have shown that prone positioning can reduce the need for mechanical ventilation and hospital mortality. Medications that have proven effective in severe forms of COVID-19 include remdesivir, systemic glucocorticoids, tocilizumab, baricitinib, and anticoagulants. Among the new promising areas of drug therapy, noteworthy is the use of thiol-containing drugs (N-acetylcysteine), inhaled surfactant, and inhaled prostacyclin analogues.