КЛИНИЧЕСКИЙ СЛУЧАЙ ТЯЖЕЛОЙ ФОРМЫ COVID-19-ИНФЕКЦИИ У ПАЦИЕНТА С ЕДИНСТВЕННЫМ ЛЕГКИМ

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In December 2019, in the People’s Republic of China (PRC) in Hubei province, cases of pneumonia caused by a coronavirus were registered, which the International Committee on the Taxonomy of Viruses (ICTV) later designated as SARS-CoV-2. The World Health Organization (WHO) has named the new disease COVID-19 [1]. Clinical symptoms in COVID-19 can vary from an asymptomatic course of the disease to a pronounced clinical picture [2,3]. Persons with concomitant pathology deserve special attention. In patients with COVID-19, arterial hypertension (13–17%), diabetes mellitus (5–35%), cardiovascular diseases (3–4%) are most often found, less often – chronic lung diseases (2%) and oncological pathology (0, 5–3%) [4]. For a number of reasons, patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay [5]. First, they frequently develop multiple organ failure with need for vasopressors, renal replacement therapy (RRT) and, in some cases, extracorporeal membrane oxygenation support. The duration of mechanical ventilation and the ICU lengths of stay of these patients are therefore usually prolonged [6, 7]. Second, COVID-19 per se is associated with significant dysfunction of the patient’s immune system. Multiple studies have shown the involvement of both innate and acquired immunity as a response to SARS-CoV-2 infection. Third, after the publication of the results of the RECOVERY trial [8], treatment with systemic corticosteroids has become standard of care in all patients requiring supplemental oxygen. Finally, secondary bacterial and fungal infections as a complication of viral respiratory diseases have been described previously, and some studies highlight their role in increasing the severity of viral pneumonia [9]. Our experience of treatment of critically ill patient with laboratory-confirmed Covid-19 and ARDS with severe comorbidities is presented in this article. Features of anamnesis, approaches to respiratory support, treatment are considered. The dynamics of clinical, laboratoric and radiologic parameters is also presented. Results: In this clinical case, despite severe concomitant pathology and a significant degree of lung tissue damage, early transfer to invasive mechanical ventilation, addition of nosocomial flora, we managed to achieve positive clinical and laboratory dynamics, weaned the patient from mechanical respiratory support on the 9th day, and on the 18th day to write out for outpatient treatment in a satisfactory condition.