Clinical efficacy of assisted intranasal ventilation after polysegmental pneumonia caused by the SARS-CoV-2 virus

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Abstract

BACKGROUND: The development of ways of rehabilitation of patients after polysegmental viral pneumonia that enable the collapsed alveoli being transferred to a ventilated and actively perfused state is certainly relevant. In this regard, non-invasive respiratory support can be considered as a reasonable additional method of treatment for these patients.

AIMS: Assess the feasibility of non-invasive assisted ventilation of the lungs after suffering polysegmental pneumonia caused by the SARS-CoV-2 virus.

MATERIALS AND METHODS: The study included 40 patients after bilateral polysegmental pneumonia caused by the SARS-CoV-2 virus. The first group of patients (21 people), in addition to the standard treatment, underwent non-invasive assisted intranasal ventilation in the BiPAP mode with a final expiratory pressure of 4–8 cm of water. Art. 60 minutes three times a day for 10–12 days. The second group (19 people) did not receive ventilation benefits. Before the start of therapy and at the end of the course, spirometry, computed tomography of the chest organs were performed with the calculation of the volume of the affected lung tissue according to the Thoracic VCAR program.

RESULTS: Upon completion of the course of treatment and rehabilitation measures in patients of the first group, the following was observed: a decrease in atelectatic changes and pneumofibrosis, an increase in the volume of ventilated areas of the lungs, the volume of the affected lung tissue according to computed tomography significantly decreased (on average, up to 26±9.8%; p <0.05). There was a significant improvement in the indicators of spirometry in the first group. The increase in the volume of forced exhalation in one second was 25–32%, while vital capacity of the lungs was 27–31%. When evaluating long-term pulse oximetry, the average saturation at night in these patients increased from 91.2±2.1 to 96.4±1.8 (p <0.05). Clinical improvement in patients of the first group led to a decrease in bed-days to an average of 15.4, while in patients of the second group it averaged 23.4 days.

CONCLUSION: The use of assisted intranasal ventilation restores the ventilation-perfusion ratio, which is confirmed by a significant improvement in clinical and instrumental parameters.

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About the authors

Vladimir V. Nikiforov

The Russian National Research Medical University named after N.I. Pirogov

Email: v.v.nikiforov@gmail.com
ORCID iD: 0000-0002-2205-9674
SPIN-code: 9044-5289

MD, Dr. Sci. (Med), Professor

Russian Federation, Moscow

Sergey V. Stebletcov

Central State Medical Academy of Department of Presidential Affairs; Clinical Hospital № 1 of Department of Presidential Affairs

Email: 7708353@mail.ru
ORCID iD: 0000-0002-5309-3330
SPIN-code: 6440-9479

MD, Cand. Sci. (Med.), Associate Professor

Moscow; Moscow

Olga M. Maslennikova

Central State Medical Academy of Department of Presidential Affairs

Email: o.m.maslennikova@gmail.com
ORCID iD: 0000-0001-9599-7381
SPIN-code: 5516-9979

MD, Dr. Sci. (Med)

Russian Federation, Moscow

Alina S. Zakirova

Central State Medical Academy of Department of Presidential Affairs

Email: zakirova.a.s.143@gmail.com
ORCID iD: 0000-0001-7214-4845
SPIN-code: 4495-5070
Russian Federation, Moscow

Olga V. Pashovkina

Clinical Hospital № 1 of Department of Presidential Affairs

Author for correspondence.
Email: dr.pashovkina@mail.ru
ORCID iD: 0000-0001-6955-4595
SPIN-code: 3448-9764
Russian Federation, Moscow

References

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Supplementary files

Supplementary Files
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1. Fig. 1. A computed tomogram (slice at Th6 level) chest organs of the patient's N.: а ― from 23.11.2020, b ― from 04.12.2020.

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2. Fig. 2. Lesion of lung vessels in COVID-19. An artery with a pillow-like thickening of the intima. Stained with hematoxylin and eosin: а ― ×100, b ― ×200.

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3. Fig. 3. An artery with a bypass vessel through which blood is discharged (circled by an oval). Stained with hematoxylin and eosin. ×200.

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