The system inflammatory syndrome is one of characteristic manifestations of severe forms of a koronavirusny infection. In this article the basic principles of treatment of an inflammatory syndrome taking into account the recommendations which are available today will be considered. It is necessary to understand that COVID-19 — an infection new and poorly studied therefore the available recommendations can change further in process of accumulation of clinical practice and emergence of results of new researches.
The first moment which should be considered concerns use of corticosteroids. At the moment the advantage of use of corticosteroid therapy for treatment of COVID-19 is unconvincing and there are certain risks. The role of corticosteroids in therapy of ORDS caused by noninfectious damages is still contradictory, and data confirm both negative, and positive impact on patients with other types of viral pneumonia, including the pneumonia caused by MERS, SARS-CoV-1 and an influenza virus. The data obtained during preliminary observation and randomized controlled studies say that the positive effect from use of steroids can be reached at treatment of persons with the COVID-19-associated ORDS and also at treatment of some patients with an anoxemia before development of ORDS, but some of these data contain the essential distorting factors, or they did not pass expert assessment yet.
Proceeding from the aforesaid, the recommendations are as follows existing now:
It is not necessary to refuse corticosteroid therapy in the presence of the main indication (for example, adrenal insufficiency, aggravation of HOZL).
For therapy of patients on IVL with/without ORDS, except for persons with an absolute or relative contraindication to use of corticosteroids, it is recommended to use dexamethasone. Such therapy has to be applied to certain subgroups of patients with care.
Dexamethasone is recommended for therapy of inpatients without absolute or relative contraindications for use of corticosteroids, with the symptoms shown seven days ago or earlier, with the level of a saturation of 94% or below (on atmospheric air), or needing additional oxygen support, including IVL.
Corticosteroids should not be applied to treatment of COVID-19 at ambulatory patients or inpatients with saturation level higher than 94% (on atmospheric air).
Reception of system steroids are associated with a number of possible side effects and complications. Though it is not clear to what degree they can be shown at COVID-19 infection, any patient to whom performing steroid therapy is planned has to be examined regarding existence of risk of development of a venous thromboembolism, reactivation of fungal, mikobakterialny or other infection, risk of gastrointestinal bleeding, a hyperglycemia with possible development a steroid - the induced diabetes, a volume overload and other symptoms. Special attention patients after transplantations deserve, a face at the age of 80 flyings and are more senior, patients with HIV and patients with a serious illness of a liver. In such groups the possibility of use of steroids has to be considered separately for each case.
The second aspect of antiinflammatory therapy at COVID-19 concerns treatment of a tsitokinovy storm. The tsitokinovy storm is understood as a state at which the activity of the immune system and processes of release of cytokines are broken, leading to developing of fever, vazogenny hypostasis and hypotension that can imitate a severe form of sepsis. The nosological forms associated with extensive release of cytokines include a syndrome of activation of macrophages and gemofagotsiticheskiya limfogistiotsitoz. It is considered that the tsitokinovy storm is the cornerstone of the clinical deterioration and the progressing damage of lungs arising at severe forms of a disease of COVID-19.
Therapy of a tsitokinovy storm is aimed at blocking of mediators of inflammation. In clinical practice were investigated and two targets showed existence of the answer: SILT-6 and SILT-1. Performance of the following therapeutic interventions specified as preference depending on availability of drugs is offered. Antitsitokinovy therapy can increase risk of an infection or break ability of an organism to struggle with the accompanying bacterial, fungal or mikobakterialny infection therefore it has to be applied with care.
Thus, it is possible to draw a conclusion that in treatment of the system inflammatory answer at COVID-19 to present timepoint there is a limited number of data and we still should learn much in this direction.