ON THE MOST SIGNIFICANT DEFECTS IN INTENSIVE CARE FOR PATIENTS WITH THE NEW CORONAVIRUS INFECTION COVID-19 BASED ON AN EXPERT ASSESSMENT
https://doi.org/10.52485/19986173_2024_4_36
Abstract
Background. There are now a sufficient number of published papers devoted to the study of various factors influencing theoutcomeofthe disease. The significance of these predictors in thenewcoronavirus infection varies depending on various anthropological factors: including regional, age, gender and medical characteristics.
The objective. To assess the significance of defects in the provision of intensive care to patients with a new coronavirus infection, presented on the basis of expert opinions, and to determine their impact on the outcome of the disease.
Materials and methods. An analysis of 93 inpatient records with the primary diagnosis of "Community- acquired bilateral polysegmental viral pneumonia, ARDS" was conducted. A simple blind sampling method was used of the medical records of patients who were treated in the intensive care unit from 01.04.2021 to 31.10.2021. A power analysis showed that a minimum sample size of 15 patients per group is sufficient to detect significant differences between the groups of survivors and deceased (power 95% and α = 0.05). The presented study was carried out as a cohort retrospective single-center study stratified into groups by the following criterion: survivors and deceased. Statistical data processing was performed using STATISTICA 10.0 and MedCalc programs. The following statistical analysis methods were used: odds ratio method, Kaplan-Meier survival analysis, log-rank test, ROC analysis.
Results. The study did not reveal any effect on the timing of death of the area of lung tissue damage upon admission. The most significant defects of intensive care affecting the chance of death in patients with a new coronavirus infection were identified. Untimely testing of a number of laboratory parameters leads to late administration of the necessary corrective therapy. The chance of an unfavorable outcome increases with a late test for ferritin, d-dimer, and procalcitonin levels. The ROC analysis showed that increased mortality is affected by: irrational and untimely antibacterial therapy – AUC equal to 0,7 with a sensitivity of 45,83% and a specificity of 94,2%, as well as untimely targeted therapy, AUC was 0.967, with a sensitivity of 100% and a specificity of 92,75%.
Conclusion. The development of an unfavorable outcome during intensive care is influenced by factors such as the untimely prescription of targeted and antibacterial therapy to patients with COVID-19 and untimely diagnostic measures, which occurred due to the incomplete material and technical equipment of medical organizations.
About the Authors
N. N. UtkinRussian Federation
Utkin N.N., Postgraduate Student of the Department of Anesthesiology and Intensive Care
100, mikrorayon Jubilejnyj, Irkutsk, Russia, 664049
V. I. Gorbachev
Russian Federation
Gorbachev V.I., Doctor of Medical Sciences, Professor, Head of the Department of Anesthesiology and Intensive Care
100, mikrorayon Jubilejnyj, Irkutsk, Russia, 664049
E. S. Netesin
Russian Federation
Netesin E.S., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care
100, mikrorayon Jubilejnyj, Irkutsk, Russia, 664049
S. V. Gorbachev
Russian Federation
Gorbachev S.V., Candidate of Medical Sciences, Associate Professor of the Department of Anesthesiology and Intensive Care
100, mikrorayon Jubilejnyj, Irkutsk, Russia, 664049
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Review
For citations:
Utkin N.N., Gorbachev V.I., Netesin E.S., Gorbachev S.V. ON THE MOST SIGNIFICANT DEFECTS IN INTENSIVE CARE FOR PATIENTS WITH THE NEW CORONAVIRUS INFECTION COVID-19 BASED ON AN EXPERT ASSESSMENT. Transbaikalian Medical Bulletin. 2024;(4):36-44. (In Russ.) https://doi.org/10.52485/19986173_2024_4_36