In March, The Patient Would "leave" For Mechanical Ventilation: The Doctor Spoke About The Change In The Treatment Tactics For COVID

In March, The Patient Would "leave" For Mechanical Ventilation: The Doctor Spoke About The Change In The Treatment Tactics For COVID
In March, The Patient Would "leave" For Mechanical Ventilation: The Doctor Spoke About The Change In The Treatment Tactics For COVID

Video: In March, The Patient Would "leave" For Mechanical Ventilation: The Doctor Spoke About The Change In The Treatment Tactics For COVID

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Video: International Learning from COVID-19 - NIV Management for Severe COVID-19 Patients I Philips 2023, February

In comparison with the spring-summer rise in the incidence of COVID-19, the tactics of treating the infection have undergone dramatic changes. Denis Protsenko, the head physician of the hospital in the Moscow village of Kommunarka, told Anton Krasovsky for the Epidemic project that doctors began to do differently.

"The fear has passed, we have learned to assess and predict a severe or mild course of infection. If in March a positive test for COVID-19 plus temperature was already an indication for hospitalization, now we are admitting critically ill patients to hospitals, whose condition is assessed on a special scale," said the medic.

Since spring, there have been heated debates about the effectiveness of many combinations of drugs against the coronavirus - hydroxychloroquine, kaletra and so on, recalls Uralinformburo.

“It was such a story 6 months long, when there was a fright when we heard somewhere [in foreign sources] that colchicine helped someone, let's treat everyone with colchicine. At the same time, we understood that all these drugs have serious side effects, "- said Protsenko.

Screenshot from RT video

The head physician also recalled that at the very beginning, when the doctors had just encountered the coronavirus, from the start, regardless of the severity of the manifestation, all patients were given the antibiotic azithromycin. "They gave it without understanding, assuming that, most likely, we are dealing with a combined infection (mixed infection. Hereinafter - editor's note), although it is quite obvious that the antimicrobial drug is active against bacteria, and not against veins. Now the prescription of antibiotics has become very restrained, "the doctor explained.

It is now obvious to doctors that there is no effective drug therapy against coronavirus. For example, drugs based on Japanese favipiravir are not used in intensive care at the 40th hospital, since they have not been studied in the group of the most severe patients. In patients with mild and moderate-severe forms, they can only shorten the time for the manifestation of symptoms of the disease.

Intensive care wards mainly use drugs to block one of the worst manifestations of COVID-19 - the cytokine storm. As a result, the survival rate for those who received these drugs (not 100% of people in intensive care), for example, tocilizumab, is twice as high, Protsenko calculated.

The doctor said that even in the case when it was possible to stop the cytokine storm in how the patient's condition will change, there may still be a lot of pitfalls. The most common problem is the addition of bacterial superinfection, which is often associated with an endogenous infected person - that is, you become infected from your own opportunistic flora, which normally lives in the intestine or oropharynx. Due to weakened immunity, it becomes pathogenic, that is, it can cause an inflammatory process, infect.

The most serious changes have taken place in the tactics of treating patients in whom the disease is most severe. For example, those who previously would have been required to be connected to a ventilator with a tube in the trachea are now successfully treated with the use of non-invasive oxygen support.

The survival rate of patients connected to mechanical ventilation, according to Protsenko, is 25%. After non-invasive ventilation, there are 90% of them, and the missing 10% are those who were intubated, that is, they moved to the first category of intubated patients.

We figured out the pathophysiology of lung tissue damage (with ongoing processes and cause-and-effect relationships).And if in March we saw a patient with low saturation (blood oxygen saturation) and it became less than 90 against the background of a high oxygen flow, this was an indication to intubate the patient's trachea and switch to invasive mechanical ventilation. Now for us, the transfer to mechanical ventilation is the very extreme point when all other measures are no longer possible, "the doctor explained.

He added that the very tactics of managing severe patients have changed.

"Now we will see at the entrance a patient lying on his stomach (this is how you can achieve better blood oxygen saturation) with non-invasive ventilation and oxygen saturation 82 (critically low), but no one grabs the intubation devices. It's just that blood counts are observed, it looks at what frequency the patient is breathing. Now we already understand that we are talking about a natural compensatory mechanism - tachycardia (increased number of heartbeats), in order to drive more blood with this oxygen through organs and tissues in conditions of oxygen deficiency. Now we are not afraid of it and do not try to remove it There are medications that can reduce this pulse, we can do it, but then everything is guaranteed to end up with the patient having to be intubated, "summed up Protsenko.

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