Metabolic therapy and its impact on lung respiratory function in patients with severe COVID-19

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Abstract

Background. Metabolic disorders, often detected in patients with severe COVID-19 infection, indicate the severity of the infection process and play an important role in the pathogenesis of the disease. Changes in muscle metabolism lead to weakness and reduced mobility of the diaphragm, which exacerbates the progression of respiratory failure.

Aim. To evaluate the effect of a meglumine sodium succinate 1.5% solution on the dynamics of metabolic blood parameters and respiratory function of the lungs in patients with COVID-19.

Material and methods. The observational prospective study included 105 patients with severe COVID-19 treated in the intensive care unit. As an infusion therapy, patients in the control group (n=54) received Ringer's solution, in the main group (n=51) — 1.5% solution of meglumine sodium succinate. Infusion therapy was carried out for 11 days. All patients underwent standard laboratory tests. Diaphragm mobility was assessed using an ultrasound scanner. Intergroup comparisons were performed using the Mann–Whitney test, and intragroup dynamics were assessed using the Kruskal–Wallis test.

Results. Upon admission to the intensive care unit, in 36.2% of patients, the development of respiratory failure was accompanied by a decrease in the excursion of the right dome of the diaphragm to less than 1.7 cm, in 92.4% of patients — the development of hyperglycemia and hyperlactatemia. By the 11th day of ongoing treatment, hyperglycemia persisted in 16.7% of patients in the control group and 3.9% of patients in the main group, hyperlactatemia — in 53.7 and 9.8% of patients, respectively. Maintenance and then gradual restoration of diaphragm excursion in patients of the main group, a decrease in hypercapnia and a gradual increase in the pO2/FiO2 index were registered. Therapy with a solution of meglumine sodium succinate significantly reduced the duration of hospital treatment after transfer from the intensive care unit (p=0.007).

Conclusion. The inclusion of a 1.5% solution of meglumine sodium succinate in the therapy of patients with severe COVID-19 can reduce the duration of metabolic disorders, which has a positive effect on the degree of respiratory dysfunction, diaphragmatic excursion depression and the treatment duration after transfer from the intensive care unit.

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About the authors

Alexey Yu. Yakovlev

Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko

Author for correspondence.
Email: aritnnru@list.ru
ORCID iD: 0000-0002-4616-5711

M.D., D. Sci. (Med.), Assoc. Prof., intensive care unit supervisor

Russian Federation, Nizhny Novgorod, Russia

Alexey A. Pevnev

City Clinical Hospital No. 30

Email: alpevnev@gmail.com
ORCID iD: 0000-0002-2293-634X

M.D., Cand. Sci. (Med.), anesthesiologist-resuscitator, City Clinical Hospital No. 30

Russian Federation, Nizhny Novgorod, Russia

Marina V. Dudorova

Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko

Email: orit.okbnn@yandex.ru

anesthesiologist-resuscitator

Russian Federation, Nizhny Novgorod, Russia

Yuri V. Ilyin

Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko

Email: goldoc@yandex.ru

M.D., Cand. Sci. (Med.), anesthesiologist-resuscitator

Russian Federation, Nizhny Novgorod, Russia

Mikhail S. Belous

Nizhny Novgorod Regional Clinical Hospital named after N.A. Semashko

Email: belousem@mail.ru
ORCID iD: 0000-0002-1869-6144

M.D., anesthesiologist-resuscitator

Russian Federation, Nizhny Novgorod, Russia

References

  1. Carrasco-Sánchez FJ, López-Carmona MD, Mar­tínez-Marcos FJ, Pérez-Belmonte LM, Hidalgo-Jiménez A, Buona­iuto V, Suárez Fernández C, Freire Castro SJ, Luordo D, Pesqueira Fontan PM, Blázquez Encinar JC, Magallanes Gamboa JO, de la Peña Fernández A, Torres Peña JD, Fernández Solà J, Napal Lecumberri JJ, Amorós Martínez F, Guisado Espartero ME, Jorge Ripper C, Gómez Méndez R, Vicente López N, Román Bernal B, Rojano Rivero MG, Ramos Rincón JM, Gómez Huelgas R; SEMI-COVID-19 Network. Admission hyperglycaemia as a predictor of mortality in patients hospita­lized with COVID-19 regardless of diabetes status: Data from the Spanish SEMI-COVID-19 Registry. Ann Med. 2021;53(1):103–116. doi: 10.1080/07853890.2020.1836566.
  2. Mazori AY, Bass IR, Chan L. Hyperglycemia is associated with increased mortality in critically ill patients with COVID-19. Endocr Pract 2021;27(2):95–100. doi: 10.1016/j.eprac.2020.12.015.
  3. Velavan TP, Le Thi Kieu Linh, Kreidenweiss A, Gabor J, Krishna S, Kremsner PG. Longitudinal monitoring of lactate in hospitalized and ambulatory COVID-19 patients. Am J Trop Med Hyg. 2021;104(3):1041–1044. doi: 10.4269/ajtmh.20-1282.
  4. Bezuidenhout MC, Wiese OJ, Moodley D, Maasdorp E, Davids MR, Koegelenberg SF, Lalla U, Khine-­Wamono AA, Zemlin AE, Allwood BW. Correlating arterial blood gas, acid-base and blood pressure abnormalities with outcomes in COVID-19 intensive care patients. Ann Clin Biochem. 2021;58(2):95–101. doi: 10.1177/0004563220972539.
  5. Alfano G, Fontana F, Mori G, Giaroni F, Ferrari A, Giovanella S, Ligabue G, Ascione E, Cazzato S, Balles­tri M, Di Gaetano M, Meschiari M, Menozzi M, Milic J, Andrea B, Franceschini E, Cuomo G, Magistroni R, Mussini C, Cappelli G, Guaraldi G; Modena Covid-19 Wor­king Group (MoCo19). Acid base disorders in patients with COVID-19. Int Urol Nephrol. 2021;11:1–6. doi: 10.1007/s11255-021-02855-1.
  6. Vassiliou AG, Jahaj E, Ilias I, Markaki V, Malachias S, Vrettou C, Ischaki E, Mastora Z, Douka E, Keskinidou C, Tsipilis S, Vassiliadi DA, Kotanidou A, Dimopoulou I. Lactate kinetics reflect organ dysfunction and are associated with adverse outcomes in intensive care unit patients with COVID-19 pneumonia: Preliminary results from a GREEK single-centre study. Metabolites. 2020;28;10(10):386. doi: 10.3390/metabo10100386.
  7. Tikhonova EO, Lyapina EP, Shuldyakov AA, Satarova SA. Use of succinate-containing agents in the treatment of infectious di­seases. Terapevticheskiy arkhiv. 2016;88(11):121–127. (In Russ.) doi: 10.17116/terarkh20168811121-127.
  8. Tolkach AB, Dolgikh VT. The influence of reamberin on oxygen balance, oxidative stress and lung dysfunction in patients with abdominal sepsis. Bulletin of Siberian Medicine. 2012;(3):69–75. (In Russ.) doi: 10.20538/1682-0363-2012-3-69-75.
  9. Usenko LV, Tsariov AV. Modern opportunities of energy protection in critical states. Meditsina neotlozhnyh sosto­yaniy. 2016;(4):72–78. (In Russ.) doi: 10.22141/2224-0586.4.75.2016.75820.
  10. Orlov YuP, Govorova NV, Korpacheva OV, Afanasyev VV, Khilenko IA. On the possibility of using succinate in hypoxia developing in COVID-19. Gene­ral reanimatology. 2021;17(3):78–98. (In Russ.) doi: 10.15360/1813-9779-2021-3-78-98.
  11. Guarracino F, Vetrugno L, Forfori F, Corradi F, Orso D, Bertini P, Ortalda A, Federici N, Copetti R, Bove T. Lung, heart, vascular, and diaphragm ultrasound examination of COVID-19 patients: A comprehensive approach. J Cardiothorac Vasc Anesth. 2021;35(6):1866–1874. doi: 10.1053/j.jvca.2020.06.013.
  12. Nekludova GV, Avdeev SN. Possibilities of ultrasound research of the diaphragm. Tera­pevticheskiy arkhiv. 2019;91(3):86–92. (In Russ.) doi: 10.26442/00403660.2019.03.000129.
  13. Philips BJ, Meguer JX, Redman J. Factors determining the appearance of glucose in upper and lower respiratory tract secretions. Intensive Care Med. 2003;29:2204–2210. doi: 10.1007/s00134-003-1961-2.
  14. Bar-Or D, Rael LT, Madayag RM. Stress hyperglycemia in critically ill patients: insight into possible molecular pathways. Front Med (Lausanne). 2019;6:54. doi: 10.3389/fmed.2019.00054.
  15. Turcato G, Panebianco L, Zaboli A, Scheurer C, Ausserhofer D, Wieser A, Pfeifer H. Correlation between arterial blood gas test and CT volumetry in patients with SARS-CoV-2 in the emergency department. Int J Infect Dis. 2020;97:233–235. doi: 10.1016/j.ijid.2020.06.033.

Supplementary files

Supplementary Files
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1. Рис. 1. Динамика экскурсии диафрагмы справа; *статистическая значимость отличий относительно исходных значений; #статистическая значимость отличий относительно значений контрольной группы

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