Anesthesia and intensive care for patients with COVID-19. Russian Federation of anesthesiologists and reanimatologists guidelines

Abstract

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.

Direct Oral Anticoagulants’ Consumption and Expenditure in the COVID-19 Pandemic in Russia and Clinical Practice Guidelines for Their Use

“…Most CPGs received high scores for this domain (89-100%), while one CPG received a lower score-67%. The CPG by the FAR [18] obtained the lowest score for this domain. We attributed it to the guidelines having a vague and not clearly defined objective.…”

Spectrum of Thrombotic Complications in Fatal Cases of COVID-19: Focus on Pulmonary Artery Thrombosis In Situ

“…The increased attention to the issue of venous thrombosis in COVID-19 has impacted the treatment strategy and preventive measures [ 18 , 42 , 43 ]. However, the ultrasound examination of the lower limbs and the prescription of low-molecular-weight heparins to all hospitalized patients with no contraindications to anticoagulant therapy did not completely solve the problem of thrombotic complications.…”

“…Since our study was based on clinical autopsy reports, we can assume that all patients received standard prophylactic doses of low-molecular-weight heparin according to the provisional guidelines in force at the time [ 18 , 42 ]. However, the frequency of thrombotic complications and the prevalence of arterial thrombosis over venous thrombosis in our study confirms the need to improve methods of preventing thrombotic complications, taking into account the pathogenesis of arterial and venous thrombosis.…”

The achievements of pulmonology and the main directions of further improvement of medical care in the Russian Federation

“…В условиях пандемии новой коронавирусной инфекции (НКИ) перед сотрудниками ФГБУ «НИИ пульмонологии» ФМБА поставлены задачи разработки и внедрения инновационных методов диагностики, лечения пациентов с COVID-19, программ реабилитации после перенесенной инфекции с использованием научно-практического потенциала в полном объеме. При этом изучены клиникоэпидемиологические характеристики инфекции COVID-19, разработаны методические рекомендации по диагностике и ведению пациентов, исследованы и внедрены в практику новые методы диагностики, лечения и реабилитации пациентов после перенесенной инфекции [5,8,15,16,[29][30][31][32][33][34][35][36][37][38]. Установлено, что НКИ поражает людей любого возраста, а риск заболевания и тяжелого течения COVID-19 имеет прямую связь с возрастом и наличием хронических болезней [29].…”

“…Обнаружено, что различные симптомы и паттерны при компьютерной томографии грудной клетки у пациентов с COVID-19 соответствуют определенным морфологическим изменениям в различные фазы диффузного альвеолярного повреждения легких [15,16]. Отмечены специфические особенности анестезиолого-реанимационного обеспечения пациентов с НКИ [32]. В борьбе за выживание пациентов с COVID-19 большое значение придается кислородотерапии и респираторной поддержке на дореанимационном этапе, а также неинвазивной вентиляции легких [33,34].…”