Acute gastrointestinal injury develops in more than half of all patients in the intensive care unit, regardless of the underlying pathology. Determining the stage of acute gastrointestinal injury is necessary to choose the appropriate strategy of intensive therapy, leading to the fast gastrointestinal function recovery. The described strategy of intensive therapy, certain approaches to enteral therapy allow to improve prognosis and to reduce the duration of the disease among patients with severe gastrointestinal injury.

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The paper presents the experience of treating a patient with acute coronary syndrome without ST segment elevation and underlying severe novel coronavirus infection (COVID-19) complicated by polysegmental viral pneumonia and significant respiratory events. Emphasis has been placed on the use of antithrombotic therapy after endovascular treatment. A 56-year-old patient underwent respiratory support (non-invasive face mask lung ventilation followed by high-flow oxygenation), urgent diagnostic coronary angiography followed by percutaneous coronary intervention (balloon angioplasty and stenting of the right coronary artery and anterior interventricular artery). In addition to the etiopathogenetic therapy for coronavirus infection, the patient received combination antithrombotic therapy, including acetylsalicylic acid, prasugrel, FRaMon monoclonal antibodies (single exposure, intraoperatively), sodium enoxaparin. The therapy resulted in normalization of hemodynamic parameters, stable normothermia, absence of catarrhal events, improvement of exercise tolerance. A chest ultrasound imaging showed consolidation events, inflammatory markers significantly decreased, circulatory deficiency events were compensated, anginal pains did not recur. On the 20th day of hospitalization, the patient was discharged home with outpatient follow-up. The use of potent antiplatelet agents such as prasugrel or ticagrelor combined with IIb/IIIa receptor inhibitors and prolonged anticoagulant therapy can potentially improve the outcome of the disease in acute coronary syndrome with underlying severe coronavirus infection. In the presented clinical example, the use of aggressive approaches to the antithrombotic therapy did not lead to the development of significant hemorrhagic or other complications.

Malnutrition is an unfavorable background for the course and outcome of viral diseases, including COVID-19. In accordance with international recommendations, timely correction of nutritional status using oral, tube enteral and parenteral nutrition is a necessary and mandatory method of concomitant therapy for COVID-19. An analytical review of the results of studies on the clinical use of pharmacological nutrients (glutamine; vitamins A, C, D, E; zinc, selenium) for the prevention and treatment of viral infections, including COVID-19, was performed. According to the data of clinical studies carried out in 2019–2020, the use of glutamine and antioxidant micronutrients as part of nutritional metabolic therapy can reduce the severity of clinical symptoms and accelerate the recovery process of patients with the new coronavirus infection COVID-19 and other viral diseases. From a practical point of view, the only sources of glutamine for enteral administration registered in the Russian Federation are Glutamine Plus for oral enteral nutrition and Intestamin for enteral tube administration and Dipeptiven 20% for parenteral nutrition. The use of pharmacological nutritional therapy, in particular, enteral or parenteral glutamine as a component of clinical nutrition in patients with viral infections and nutritional deficiency or the risk of its development, helps to improve clinical results, reduce the severity of the disease and accelerate the rehabilitation process.

Nutritional deficit in patients with viral diseases, including COVID-19, can reduce the efficacy of specific treatment, decrease the survival rate, and increase medical expenses. According to international guidelines, timely correction of nutritional status with supplemental enteral and parenteral nutrition containing omega-3 polyunsaturated fatty acid from fish oil (omega-3 PUFAs: ЕРА and DHA) is able to improve clinical outcomes of specific antiviral treatment. The authors conducted an analytical review to assess the results from the study of clinical use of omega-3 PUFAs for the prevention and treatment of COVID-19 and other viral infections. Supplementation of clinical (enteral and parenteral) nutrition with omega-3 PUFAs allows for symptom reduction, shorter stay in hospital, and quicker recovery of patients infected with SARS-CoV-2 and other viruses. When used in combination with adequate macronutrient support, it can reverse nutritional deficit and improve clinical outcomes.