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The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was February 01, 2021. To develop the recommendations for the Guidelines, were used documents directly describing the features of the management of patients with NCI COVID-19 (guidelines - 34; randomized clinical trials and Cochrane Reviews - 13; observational and comparative studies - 107; other documents, notes and comments - 64), and documents describing anesthesia and intensive care in the general population of patients. Compared to the previous 4th version of the guidelines, the recommendations in 8 sections have been corrected; new subsections “Chronic kidney disease”, “Rehabilitation treatment of patients with COVID-19 in the intensive care unit”, “Routing of patients with COVID-19 to the stages of rehabilitation” were created; revised 1 Appendix, additionally developed 7 Appendices; the section “Quality criteria” has been supplemented. The provisions of the current version of the guidelines highlight the specifics of anesthesia, intensive care, rehabilitation, resuscitation measures, manipulation, transportation, prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis, drug interactions are described. The features of management of pregnant women, children of different age groups, patients with concomitant diseases, the principles of the formation of stocks of drugs and consumables are considered.

The article provides the main statements of the guidelines for the anesthesia and intensive care of patients with the coronavirus disease (COVID-19), developed by the Federation of Anesthesiologists and Reanimatologists of Russia. In the process of developing the recommendations, the publications of the official websites of the Russian Federation, the electronic databases of the RSCI, PubMed, MEDLINE, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were analyzed by the developers independently of each other. The date of the last search query was June 29, 2020. To develop the Guidelines for the recommendations, were used documents that directly describing the features of the management of patients with coronavirus disease COVID-19 (guidelines and guidelines - 16; randomized clinical trials and Cochrane Reviews - 8; observational and comparative studies - 77; other documents, notes and comments - 54) and describing anesthetic and resuscitation support in the general population of patients. The provisions of the recommendations highlight the specifics of anesthesia, intensive care, resuscitation, manipulation, and prevention of the spread of COVID-19 in the implementation of these activities. Methods of protecting personnel from infection with COVID-19 during manipulations, anesthesia and intensive care are considered. The features of respiratory support, extracorporeal detoxification, extracorporeal membrane oxygenation, thromboprophylaxis are described. The features of the management of pregnant women, children of different age, patients with concomitant diseases, issues of transportation of patients are considered.

Introduction. The article presents the problems of the use of glucocorticosteroids in the treatment of patients with coronavirus– associated pneumonia (COVID-19) without hypoxemia. The experience of the preemptive use of low doses of glucocorticosteroids in the treatment of such patients in a hospital is described. Simplification of a unified scheme of pathogenetic therapy with glucocorticosteroids in the above patients is urgent. The article highlights the effectiveness of the early use of low doses of glucocorticosteroids in the treatment of a specific cohort of patients with COVID-19.Objective. To assess the clinical efficacy and safety of early use of small doses of methylprednisolone in the comprehensive therapy of patients with moderate to severe COVID-19 pneumonia to prevent the development of complications and improve the outcomes of the disease.Materials and methods. The study included 40 hospitalized patients from 37 to 68 years (average age 52. years) with a diagnosis of moderate to severe COVID-19 pneumonia. Patients were randomized into two groups: the main group (n = 20) and the control group (n = 20). The main group additionally received methylprednisolone: 4 mg tablets, 7 tablets per day, divided into 2 doses (4 tablets in the morning and 3 tablets at lunchtime). The effectiveness of the therapy was evaluated based on the primary combined endpoint of the study, which included progression of the disease to an extremely severe form or the occurrence of pulmonary and extrapulmonary complications that required transfer to the intensive care unit, or death of the patient during the followup period. The secondary combined endpoint of the study was resolution of clinical symptoms of the disease or achievement of reference values of laboratory and instrumental indicators.Results. No lethal outcomes were observed in the compared groups, there were no cases of development of an extremely severe course, complications requiring transfer to the intensive care unit in the main group.Conclusion. Early use of small doses methylprednisolone of in comprehensive therapy of patients with moderate and severe COVID-19 pneumonia reduces the incidence of life-threatening complications and improves the outcomes of the disease.

BACKGROUND. Ultrasound study significantly expanded the possibilities of bedside diagnosis in patients with respiratory failure. Using ultrasound, it is possible to determine the volume of lung damage in the form of collapsed alveoli and infiltration areas with preserved airness of the lung tissue. AIM OF STuDY To study the possibility of assessing the recruitment maneuver of the alveoli based on changes in the ultrasound signs of lung tissue damage.MATERIAL AND METHODS. A prospective study was performed in the Clinic of Anesthesiology and Resuscitation of S.M. Kirov Military Medical Academy. The study included 36 patients who were treated in the period from 2010 to 2017 with a duration of respiratory support of at least 48 hours and oxygenation index less than 300 mmHg. For 36 patients, 48 alveoli recruitment maneuvers were performed according to a step-by-step method under the control of dynamic compliance and average tidal volume. Ultrasound determined the type and extent of destruction of lung tissue by signs of infiltration and consolidation.RESULTS. In the studied patients, after carrying out a maneuver of recruitment of the alveoli, arterial blood oxygenation indices increased statistically significantly, PaCO2 level decreased, pulmonary tissue compliance improved, respiratory volume grew. All this confirmed the mobilization of the alveoli and improved lung ventilation. Ultrasonographic evaluation of lung tissue showed a significant decrease in the severity of the ultrasound sign of infiltration after recruitment maneuver from 46.5 (38; 57.5) to 37.5 (30.5; 49.5). However, recruitment had practically no effect on the volume of the consolidated area of lung tissue: the general consolidation index before (4 (3; 5)) and after (4 (3; 5)) the maneuver had no statistically significant differences.CONCLUSIONS. The pneumonia-affected consolidated lung tissue has a low recruitment potential and the volume of consolidation does not change with the growth of PEEP. After the recruitment maneuver, the number of B-lines decreases, indicating a decrease in infiltration and an increase in lung airness.Authors declare lack of the conflicts of interests.