A.I. Burnasyan Scientific journal FMBC

Clinical Bulletin

ISSN 2782-6430 (print)

State Research Center −Burnasyan Federal Medical Biophysical
Center of Federal Medical Biological Agency

The journal is published in Russian.
Format – A4.
The periodicity of the journal is 4 times a year.

Issue №3 2022 год

A.I. Burnasyan  FMBC clinical bulletin. 2022 № 1

Clinical Case of Single Lung Patient with Severe Covid-19 Infection
Belsky V.A., Mironov A.A.
Clinical Case of Single Lung Patient with Severe Covid-19 Infection, Nizhny Novgorod, Russia

Contact person: Vladislav Belsky, vlad.belsky@gmail.com

In December 2019, in the People’s Republic of China (PRC) in Hubei province, cases of pneumonia caused by a coronavirus were registered, which the International Committee on the Taxonomy of Viruses (ICTV) later designated as SARS-CoV-2. The World Health Organization (WHO) has named the new disease COVID-19 [1]. Clinical symptoms in COVID-19 can vary from an asymptomatic course of the disease to a pronounced clinical picture [2,3]. Persons with concomitant pathology deserve special attention. In patients with COVID-19, arterial hypertension (13–17%), diabetes mellitus (5–35%), cardiovascular diseases (3–4%) are most often found, less often – chronic lung diseases (2%) and oncological pathology (0, 5–3%) [4].

For a number of reasons, patients with COVID-19 admitted to the ICU are at high risk of developing infectious complications during their ICU stay [5]. First, they frequently develop multiple organ failure with need for vasopressors, renal replacement therapy (RRT) and, in some cases, extracorporeal membrane oxygenation support. The duration of mechanical ventilation and the ICU lengths of stay of these patients are therefore usually prolonged [6, 7]. Second, COVID-19 per se is associated with significant dysfunction of the patient’s immune system. Multiple studies have shown the involvement of both innate and acquired immunity as a response to SARS-CoV-2 infection. Third, after the publication of the results of the RECOVERY trial [8], treatment with systemic corticosteroids has become standard of care in all patients requiring supplemental oxygen.

Finally, secondary bacterial and fungal infections as a complication of viral respiratory diseases have been described previously, and some studies highlight their role in increasing the severity of viral pneumonia [9].

Our experience of treatment of critically ill patient with laboratory-confirmed Covid-19 and ARDS with severe comorbidities is presented in this article. Features of anamnesis, approaches to respiratory support, treatment are considered. The dynamics of clinical, laboratoric and radiologic parameters is also presented.

Results: In this clinical case, despite severe concomitant pathology and a significant degree of lung tissue damage, early transfer to invasive mechanical ventilation, addition of nosocomial flora, we managed to achieve positive clinical and laboratory dynamics, weaned the patient from mechanical respiratory support on the 9th day, and on the 18th day to write out for outpatient treatment in a satisfactory condition.

Keywords: Covid-19-associated pneumonia, comorbidity, pulmonectomy, clinical and laboratory parameters, intensive care, artificial lung ventilation, clinical case

For citation: Belsky V.A., Mironov A.A. Clinical Case of Single Lung Patient with Severe Covid-19 Infection. A.I. Burnasyan Federal Medical Biophysical Center Clinical Bulletin. 2022.1:36-39. (In Russian) DOI: 10.33266/2782-6430-2022-1-36-39

1. Bevova M.R., Netesov S.V., AulchenkoYu.S. New Coronavirus Infection COVID-19. Molekulyarnaya Genetika, Mikrobiologiya i Virusologiya = Molecular Genetics, Microbiology and Virology. 2020;38;2:51-58. DOI: 10.17116/molgen20203802151. (In Russ.).
2. Mehra M.R., Desai S.S., Kuy S., et al. Cardiovascular Disease, Drug Therapy and Mortality in Covid-19. N. Engl. J. Med. 2020;382:e102. DOI: 10.1056/NEJMoa2007621.
3. Wang C., Hornby P.W., Hayden F.G., Gao G.F. A Novel Coronavirus Outbreak of Global Health Concern. Lancet. 2020;395;10223:470–473. DOI: 10.1016/S0140-6736(20)30185-9.
4. Starshinova A.A., Kushnareva YE.A., Malkova A.M., Dovgalyuk I.F., Kudlay D.A. New Coronaviral Infection: Features of Clinical Course, Capabilities of Diagnostics, Treatment and Prevention in Adults and Children. Voprosy Sovremennoy Pediatrii = Current Pediatrics. 2020;19;2:123-131. DOI: 10.15690/vsp. v19i2.2105. (In Russ.).
5. Grasselli G., Cattaneo E., Florio G. Secondary Infections in Critically Ill Patients with COVID-19. Crit Care 2021;25:317. DOI: 10.1186/s13054-021-03672-9.
6. Grasselli G., Greco M., Zanella A., et al. Risk Factors Associated with Mortality Among Patients with COVID-19 in Intensive Care Units in Lombardy, Italy. JAMA Intern Med. 2020;180;10:1345-1355. DOI: 10.1001/jamainternmed.2020.3539.
7. COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators. Clinical Characteristics and Day-90 Outcomes of 4244 Critically Ill Adults with COVID-19: a Prospective Cohort Study. Intensive Care Med. 2021;47;1:60-73. DOI: 10.1007/s00134-020-06294-x.
8. RECOVERY Collaborative Group, Horby P., Lim W.S., et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med. 2021;384;8:693-704. DOI: 10.1056/NEJMoa2021436.
9. Morris D.E., Cleary D.W., Clarke S.C. Secondary Bacterial Infections Associated with Influenza Pandemics. Front. Microbiol. 2017;8:1041. DOI: 10.3389/fmicb.2017.01041.

Conflict of interest. The authors declare no conflict of interest.
Financing. The study had no sponsorship.
Contribution. Article was prepared with equal participation of the authors.
Article received: 20.01.2022.  Accepted for publication: 01.02.2022 


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