Abstract
The aim. Determine hemodynamic status and its impact on oxygen transport, frequency of adverse events and outcomes in patients with severe SARS-CoV-2 associated with acute respiratory distress syndrome (ARDS).
 Materials and methods. A single-center prospective comparative study was conducted with 29 patients enrolled over the period of July—October 2020 who suffered a severe course of coronavirus disease and bilateral pneumonia associated with ARDS. Based on the estimated cardiac index (CI), patients were allocated to two groups: Group 1 included 14 patients with severe ARDS and CI 1.9 [1.5–2.5] L/min/m2, whereas Group 2 included 15 patients with CI 4.2 [3.2–8.1] L/min/m2 (p=0.001). Patient`s intensive care was regulated by the relevant orders of the Ministry of Health of Ukraine. Statistical analysis of the results was carried out using Statistica 10 software. Statistical significance of parameters was assessed using the non-parametric Wilcoxon criterion. Results were considered significant at p values <0.05. Data are presented as M [25–75]. Relative risk (RR) and odds ratio (OR) of adverse events were calculated.
 Results. The severe course of coronavirus disease is associated with significant oxygen transport disorders that increase with hypovolemia. Despite the increase in oxygen delivery in the group with normal CI its high tissue extraction remained, which may be a sign of development mitochondrial distress.
 Conclusions. Patients admitted to the ICU with severe COVID-19 may be in a state of hypovolemia and require individual assessment of hemodynamic status and the appointment of infusion therapy. Increased oxygen delivery in patients with normal cardiac index was associated with decreased adverse events rate and statistically significant decrease of mortality rate
Highlights
The basis of critical care is this or that way related to control of oxygen transport and prevention of its disorders or correction thereof
Materials and methods A single-center prospective comparative study was conducted with 29 patients enrolled over the period of July-October 2020 who suffered a severe course of coronavirus disease and bilateral pneumonia associated with acute respiratory distress syndrome (ARDS)
The severe and critical course of COVID-19 with the development of ARDS is associated with significant impairments in oxygen transport and consumption aggravated by hypovolemia
Summary
The basis of critical care is this or that way related to control of oxygen transport and prevention of its disorders or correction thereof. When oxygen transport is impaired due to heart failure or hypovolemia (for example due to bleeding), the causes of tissue hypoxia are clear and their correction is not challenging. Oxygen transport disorders are less clear in other severe conditions such as ARDS, and sepsis [1, 2]. According to some study results, among patients admitted to hospital with COVID-19, 33 % manifest with ARDS, 26 % require transfer to the intensive care unit (ICU), 16 % require mechanical ventilation (MV), and 16 % die [3, 4]. Among COVID-19 patients transferred to ICU 63 % require mechanical ventilation, and 75 % have ARDS [5]. A mortality rate of ICU patients with COVID-19 is 40 %, and 59 % of patients are on mechanical ventilation; a mortality rate related (2021), «EUREKA: Health Sciences» Number 1 to COVID-19-associated ARDS is 45 %, and ARDS rate among those who did not survive with COVID-19 is 90 % [6, 7]
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