Abstract
Purpose. To assess changes in the degree of pulmonary injury in patients with Sars-CoV-2 after extracorporeal hemocorrection methods (ECHCM).Material and methods. 27 patients with Sars-CoV-2 underwent 48 ECHCM procedures - plasma separation, nonselective cytosorption hemoperfusion, dialysis-filtration techniques. After arriving in the hospital all patients underwent MSCT of the chest organs. The examination was conducted according to the standard protocol of MSCT of the chest organs and reconstruction of soft and high-resolution on a Philips Ingenuity CT 64 multi- detector computed tomograph. The following scanning parameters were used for the standard protocol: 64 × 0.625 collimation, 1 mm reconstruction, 0.5 mm increment. The patient was lying on his back with his arms thrown back behind his head during the procedure. A scan area including the chest was planned by the plan scan. Assessment of the scans was carried out in the Diсom-images viewing module of medical hardware- software complex “ArchiMed” (Med-Ray. Russia, 2004). The percentage of lung parenchyma lesions as well as the severity (CT-1–4) were evaluated according to the recommendations “Radiation diagnosis of coronavirus disease (COVID-19): organization, methodology, interpretation of the results”. CT examinations were compared not earlier than 4 days before ECHCM and not later than 5 days after.Result. With isolated plasmaseparation, the “ground glass” zones passed into the consolidation zones, the total volume of the lesion decreased and the pneumatization increased. In isolated hemoperfusion the dynamics is multidirectional: there are more consolidation zones, less ground glass zones in general, the process is stabilized and the zones of lung tissue damage are reduced. With isolated hemodiafiltration, the consolidation zones decreased, the pneumatization of the lung tissue increased, and subsequently the volume of the lesion and the consolidation zones increased significantly. By combined procedures there are multidirectional dynamics.Conclusion. The effect of ECMGC use on the degree and volume of lung tissue damage in patients with Sars- CoV-2 was not revealed.
Highlights
During the ongoing COVID-19 pandemic, more than 13.8% of cases are severe and 6.1% are critical [1]
Interleukin-6 usually increases with ferritin and C-reactive protein, and this is considered a risk factor for the development of acute respiratory distress syndrome (ARDS) [3]
In the recommendations of the Association of Anesthesiologists and Intensive Care Physicians of the Russian Federation on the use of extracorporeal hemocorrection methods (ECHCM), three scenarios of their use are identified [7], 18 МЕДИЦИНСКАЯ ВИЗУАЛИЗАЦИЯ 2020, том 24, No3 which are partially included in the 7th Temporary Recommendations for the Treatment of Coronavirus Infection of the Ministry of Health of the Russian Federation [8]
Summary
A.V. Vishnevsky was reassigned to a hospital to treat patients with a new coronavirus infection. When arrived at the hospital, all patients underwent MSCT of the chest organs. The examination was conducted according to the standard protocol of MSCT of the chest organs and reconstruction of soft and high-resolution on a Philips Ingenuity CT 64 multi- detector computed tomograph. The percentage of lung parenchyma lesions, as well as the severity (CT-1–4) were evaluated according to the recommendations “Radiation diagnosis of coronavirus disease (COVID-19): organization, methodology, interpretation of the results” of the Moscow State Budgetary Healthcare Institution “Scientific and Practical Clinical Diagnostic Center and telemedicine technologies of the Moscow Health Department ”version 2 (04.17.2020) [9]. Except for the primary CT-scan, follow-up examinations were carried out every 4 days or when clinical presentation changed
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