A new look at the correction of COVID-19-mediated pulmonary gas exchange disorders

Abstract

Aim. To assess the effect of meglumine sodium succinate on the effectiveness of basic therapy in correcting gas exchange abnormalities in patients with severe COVID-19 infection complicated by bilateral community-acquired pneumonia.

Methods. The analysis of the effectiveness of therapy of 12 patients with a diagnosis of “New coronavirus infection COVID-19 (confirmed), severe form U07.1. Complication: bilateral multifocal pneumonia” was carried out. The patients were divided into two groups: 7 received, as part of standard therapy, a solution of meglumine sodium succinate in a daily dose of 5 ml/kg during stay in the intensive care unit; 5 patients received a similar volume of Ringer's solution and formed the control group. In the arterial and venous blood of all patients, the indicators of acid-base state and water-electrolyte balance, glycemia and lactatemia were measured at several stages: (1) at admission to the intensive care unit, (2) 2–4 hours after the start of intensive therapy, (3) after 8–12 hours, (4) after 24 hours. On the 28th day of observation, mortality, the duration of treatment in the intensive care unit and the incidence of thrombotic complications in the groups were assessed. The Friedman nonparametric hypothesis test was used to assess intragroup dynamics, and the nonparametric Mann–hitney U test for intergroup comparisons.

Results. In the group of patients who received meglumine sodium succinate, there was a significant decrease in the incidence of thromboembolic events during 28 days of treatment: myocardial ischemia event rate ratio from 0.89 [95% confidence interval (CI) 0.19–1.16] in the control group to 0.55 (95% CI 0.06–0.81) in the study group at p=0.043; pulmonary embolism event from 0.50 (95% CI 0–1.0) in the control group to 0.28 (95% CI 0–1.0) in the study group at p=0.041. There was also a decrease in the duration of intensive care unit length of stay to 6.1±1.1 days in the study group versus 8.9±1.3 days in the control group.

Conclusion. Compared with standard infusion therapy, the use of meglumine sodium succinate leads to a faster normalization of ventilation-perfusion ratios in patients with severe coronavirus infection.

Keywords

coronavirus infection / COVID-19 / endothelium / meglumine sodium succinate

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Simutis I.S., Boyarinov G.A., Yuriev M.Y., Petrovsky D.S., Kovalenko A.I., Sapozhnikov K.V.