COVID-19 Hastalarında Akut Solunum Sıkıntısı Sendromu Yönetimi

Öz

Covid 19, koronovirüsün, şiddetli akut solunum sıkıntısı sendromuna neden olduğu bulaşıcı bir hastalıktır. İlk vaka 2019'da Çin'in Wuhan kentinde tespit edildi. Hastalık o zamandan beri dünya çapında yayılarak bir pandemiye yol açtı. Çoğu insan hafif ila orta şiddette semptomlara sahip olsa da, hastaların % 5'i kritik semptomlara (ARDS, şok, çoklu organ yetmezliği) sahiptir. Kalp hastalığı, hipertansiyon, diyabet ve kronik obstrüktif akciğer hastalığı gibi mevcut sağlık koşullarına sahip kişiler ve bağışıklık sistemi zayıflamış kişiler, daha ciddi komplikasyonlar için daha yüksek risk altındadır. Akut solunum sıkıntısı sendromu (ARDS), akciğerlerde hızlı başlayan yaygın inflamasyon ile karakterize bir solunum yetmezliği türüdür. Koronavirüsün neden olduğu hastalık olan COVID-19, pnömoni gibi akciğer komplikasyonlarına ve şiddetli vakalarda akut solunum sıkıntısı sendromuna (ARDS) neden olabilir. Bu duruma COVID-19 ile ilişkili akut solunum sıkıntısı sendromu (CARDS) denir. CARDS' a özgü mekanizmalar ve komorbiditeler mevcuttur ve bazı yönleri ile atipik bir ARDS olduğu düşünülebilir. Önemli olarak, CARDS için spesifik kanıta dayalı tıbbi müdahaleler şu anda mevcut değildir ve tedavi çabaları çoğunlukla destekleyici YBÜ bakımı ile sınırlıdır. CARDS yönetimi, önemli klinik ikilemler ortaya çıkarmaktadır. Şu anda hastalığa özgü tedavi yaklaşımının bulunmadığı spesifik CARDS durumunda, önleyici tedbirlerin özel bir önemi olduğu görülmektedir. Bu derlemede, altta yatan pulmoner patofizyolojiyi ve CARDS'ın klinik yönetimini tartışacağız.

Anahtar Kelimeler

• ARDS
• Covid 19
• Covid 19 ilişkili akut solunum sıkıntısı sendromu

Acute Respiratory Distress Syndrome Management in COVID-19 Patients

Öz

COVID-19 is a contagious disease caused by severe acute respiratory distress syndrome coronovirus. The first case was identified in Wuhan, China, in 2019. The disease has since spread worldwide, leading to an ongoing pandemic. Most people develop mild to moderate symptoms, only 5% of patients suffer critical symptoms (ARDS, shock, multiorgan dysfunction). People with existing health conditions like heart disease, hypertension, diabetes, and chronic obstructive pulmonary disorder, and people with a compromised immune system are at higher risk for more severe complications. Acute respiratory distress syndrome (ARDS) is a type of respiratory failure characterized by rapid onset of widespread inflammation in the lungs. COVID-19, the disease caused by the coronavirus, can cause lung complications such as pneumonia and, in the most severe cases, acute respiratory distress syndrome (ARDS). This state is called COVID-19-associated acute respiratory distress syndrome (CARDS). CARDS-specific mechanisms and comorbidities can be noted and some aspects of CARDS can be considered ARDS atypical. Importantly, specific evidence-based medical interventions for CARDS are currently unavailable, limiting treatment efforts to mostly supportive ICU care. The management of CARDS poses significant clinical dilemmas. In the specific setting of CARDS, with currently no disease-specific treatment approach available, preventive measures appear to be of a particular importance. In this review, we will discuss the underlying pulmonary pathophysiology and the clinical management of CARDS.

Anahtar Kelimeler

• ARDS
• Covid 19
• COVID-19-associated acute respiratory distress syndrome,

Kaynakça

1. Kaynaklar Referans1. World Health Organization 2020. Coronavirus disease (‎ COVID-19)‎.
2. Referans2. Diamond M, Peniston Feliciano HL, Sanghavi D, Mahapatra S. Acute Respiratory Distress Syndrome [Internet]. In: StatPearls Treasure Island (FL): StatPearls Publishing; 2021
3. Referans3. Park WY, Goodman RB, Steinberg KP, Ruzinski JT, Radella F 2nd, Park DR et al. Cytokine balance in the lungs of patients with acute respiratory distress syndrome. Am J Respir Crit Care Med 2001;15:164(10).
4. Referans4. Huang X, Xiu H, Zhang S, Zhang G. The Role of Macrophages in the Pathogenesis of ALI/ARDS. Mediators Inflamm 2018;13:1264913.
5. Referans5. Zhang X, Li S, Niu S. "ACE2 and COVID-19 and the resulting ARDS." Postgrad Med J 2020; 96: 403-7
6. Referans6. Xu Z, Shi L, Wang Y, Zhang J, Huang L, Zhang C et al. Pathological findings of COVID-19 associated with acute respiratory distress syndrome. Lancet Respir Med 2020; 8:420–2.
7. Referans7. Dalan R, Bornstein SR, El-Armouche A, Rodionov RN, Markov A, Wielockx B et al. The ACE-2 in COVID-19: Foe or Friend? Horm Metab Res 2020;52(5):257-63.
8. Referans8. Batah SS, Fabro AT. Pulmonary pathology of ARDS in COVID-19: A pathological review for clinicians. Respir Med 2021;176:106239.

9. Referans9. Force A.D.T. Acute respiratory distress syndrome: the Berlin Definition. J. Am. Med. Assoc 2012;307(23):2526–33.
10. Referans10. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet 2020;28:1054-62.
11. Referans11. Li X, Ma X. Acute respiratory failure in COVID-19: is it "typical" ARDS? Crit Care. 2020 May 6;24(1):198.
12. Referans12. Gattinoni L, Chiumello D, Caironi P, Busana M, Romitti F, Brazzi L, Camporota L. COVID-19 pneumonia: different respiratory treatments for different phenotypes?. Intensive Care Med. 2020
13. Referans13. Goligher EC, Ranieri VM, Slutsky AS. Is severe COVID-19 pneumonia a typical or atypical form of ARDS? And does it matter?. Intensive Care Med 2021;47(1):83-85.
14. Referans14. Gibson PG, Qin L, Puah SH. COVID-19 acute respiratory distress syndrome (ARDS): clinical features and differences from typical pre-COVID-19 ARDS. Med J Aust 2020;213(2):54-56.
15. Referans15. Tobin MJ. Pondering the atypicality of ARDS in COVID-19 is a distraction for the bedside doctor. Intensive Care Med 2021;47(3):361-2.
16. Referans16. Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, et al. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted? Lancet Respir Med 2020;8(8):816-21
17. Referans17. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016; 315: 788–800.
18. Referans18. Wu C, Chen X, Cai Y, Xia J, Zhau X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med 2020
19. Referans19. Khilnani GC, Hadda V. Corticosteroids and ARDS: A review of treatment and prevention evidence. Lung India. 2011;28(2):114-119. doi:10.4103/0970-2113.80324
20. Referans20. Matera MG, Rogliani P, Calzetta L, Cazzola M. Pharmacological management of COVID-19 patients with ARDS (CARDS): A narrative review. Respir Med. 2020;171:106114. doi:10.1016/j.rmed.2020.106114
21. Referans21. Guo, Wei-guang MD; Fang, Bin MD; Xian, Yan-shan MD; Yu, Zhi-hui MD; Zhou, Li-xin MD∗ Successful treatment of a critically ill patient with acute respiratory distress syndrome from COVID-19 using mechanical ventilation strategy with low levels of positive end-expiratory pressure, Medicine: December 4, 2020 - Volume 99 - Issue 49 - p e23160 doi: 10.1097/MD.0000000000023160
22. Referans22. Tsatsakis A, Calina D, Falzone L, Petrakis L, Mitrut R, Siokas V, et al. SARS-CoV-2 pathophysiology and its clinical implications: An integrative overview of the pharmacotherapeutic management of COVID-19. Food Chem Toxicol 2020;146:111769.
23. Referans23. Kassirian S, Taneja R, Mehta S. Diagnosis and Management of Acute Respiratory Distress Syndrome in a Time of COVID-19. Diagnostics (Basel) 2020;10(12):1053.
24. Referans24. Annane D, Pastores SM, Rochwerg B, Arlt W, Balk RA, Beishuizen A, et al Guidelines for the Diagnosis and Management of Critical Illness-Related Corticosteroid Insufficiency (CIRCI) in Critically Ill Patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Crit Care Med 2017;45(12):2078-88.
25. Referans25. Meduri GU, Bridges L, Shih MC, Marik PE, Siemieniuk RAC, Kocak M. Prolonged glucocorticoid treatment is associated with improved ARDS outcomes: analysis of individual patients' data from four randomized trials and trial-level meta-analysis of the updated literature. Intensive Care Med 2016;42(5):829-40.
26. Referans26. Alhazzani W, Møller MH, Arabi YM, Loeb M, Gong MN, Fan E, et al. Surviving Sepsis Campaign: guidelines on the management of critically ill adults with Coronavirus Disease 2019 (COVID-19). Intensive Care Med 2020;46(5):854-87.
27. Referans27. Horby P, Lim WS, Emberson JR, Mafham M, Bell JL, Linsell L, et al. RECOVERY Collaborative Group. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med 2021; 25;384(8):693-704.
28. Referans28. Yang Z, Liu J, Zhou Y, Zhao X, Zhao Q, Liu J. The effect of corticosteroid treatment on patients with coronavirus infection: a systematic review and meta-analysis. J Infect. 2020;81(1):e13-e20.
29. Referans29. Ye Z, Wang Y, Colunga-Lozano LE, Prasad M, Tangamornsuksan W, Rochwerg B, et al. Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2020; 6:192(27):E756-E767.
30. Referans30. Ackermann M, Verleden SE, Kuehnel M, Haverich A, Welte T, Laenger F, et al. Pulmonary Vascular Endothelialitis, Thrombosis, and Angiogenesis in Covid-19. N Engl J Med 2020;9;383(2):120-128.
31. Referans31. Paranjpe I, Fuster V, Lala A, Russak AJ, Glicksberg BS, Levin MA, et al. Association of Treatment Dose Anticoagulation With In-Hospital Survival Among Hospitalized Patients With COVID-19. J Am Coll Cardiol. 2020;7:76(1):122-124.
32. Referans32. Li J, Li Y, Yang B, Wang H, Li L. Low-molecular-weight heparin treatment for acute lung injury/acute respiratory distress syndrome: a meta-analysis of randomized controlled trials. Int J Clin Exp Med 2018; 11(2), 414-22.
33. Referans33. Parikh R, Wilson C, Weinberg J, Gavin D, Murphy J, Reardon CC. Inhaled nitric oxide treatment in spontaneously breathing COVID-19 patients. Ther Adv Respir Dis. 2020;14:1753466620933510.
34. Referans34. Pan C, Chen L, Lu C, Zhang W, Xia JA, Sklar MC, et al. Lung Recruitability in COVID-19-associated Acute Respiratory Distress Syndrome: A Single-Center Observational Study. Am J Respir Crit Care Med 2020; 15:201(10):1294-7.
35. Referans35. Tavernier E, McNicholas B, Pavlov I, Roca O, Perez Y, Laffey J, et al. Awake prone positioning of hypoxaemic patients with COVID-19: protocol for a randomised controlled open-label superiority meta-trial. BMJ Open 2020;10(11):e041520.
36. Referans36. Koulouras V, Papathanakos G, Papathanasiou A, Nakos G. Efficacy of prone position in acute respiratory distress syndrome patients: A pathophysiology-based review. World J Crit Care Med 2016;5(2):121-136.
37. Referans37. Stawicki SP, Jeanmonod R, Miller AC, Paladino L, Gaieski DF, Yaffee AQ, et al. The 2019-2020 Novel Coronavirus (Severe Acute Respiratory Syndrome Coronavirus 2) Pandemic: A Joint American College of Academic International Medicine-World Academic Council of Emergency Medicine Multidisciplinary COVID-19 Working Group Consensus Paper. J Global Infect Dis 2020; 12(2): 47–93.
38. Referans38. Vollenberg R, Matern P, Nowacki T, Fuhrmann V, Padberg JS, Ochs K, et al. Prone Position in Mechanically Ventilated COVID-19 Patients: A Multicenter Study. J Clin Med 2021;10(5):1046.
39. Referans39. Calligaro GL, Lalla U, Audley G, Gina P, Miller MG, Mendelson M, et al. The utility of high-flow nasal oxygen for severe COVID-19 pneumonia in a resource-constrained setting: A multi-centre prospective observational study. EClinical Medicine 2020; 28: 100570.
40. Referans40. Artigas RM, Ferreyro BL, Angriman F, Hernández-Sanz M, Arruti E, Torres A, et al. High-flow nasal oxygen in patients with COVID-19-associated acute respiratory failure. Critical Care 2021; 25(1): 1-10.
41. Referans41. Roca O, Caralt B, Messika J, Samper M, Sztrymf B, Hernández G et al. An Index Combining Respiratory Rate and Oxygenation to Predict Outcome of Nasal High FlowTherapy. Am J Respir Crit Care Med 2018
42. Referans42. Patel M, Chowdhury J, Mills N, Marron R, Gangemi A, Dorey-Stein Z, et al. ROX Index Predicts Intubation in Patients with COVID-19 Pneumonia and Moderate to Severe Hypoxemic Respiratory Failure Receiving High Flow Nasal Therapy. medRxiv2020
43. Referans43. Bellani G, Laffey JG, Pham T, Madotto F, Fan E, Brochard L, et al. Noninvasive ventilation of patients with acute respiratory distress syndrome: insights from the LUNG SAFE Study. Am J Respir Crit Care Med. 2017;195(1):67 77.
44. Referans44. Lucchini A, Giani M, Isgrò S, Rona R, Foti G. The “helmet bundle” in COVID-19 patients undergoing non invasive ventilation. Intensive & critical care nursing 2020; 58:102859.
45. Referans45. Jainn A, Doyle DJ. (2020). Stages or phenotypes? A critical look at COVID-19 pathophysiology. Intensive care medicine 2020; 46: 1494-5.
46. Referans46. Möhlenkamp S, Thiele H. Ventilation of COVID-19 patients in intensive care units. Herz 2020;45(4):329-331.
47. Referans47. Wunsch H. Mechanical Ventilation in COVID-19: Interpreting the Current Epidemiology. Am J Respir Crit Care Med 2020;202(1):1-4.
48. Referans48. Vries H, Endeman H, Hoeven J, Heunks L. Lung-protective mechanical ventilation in patients with COVID-19. Neth. J. Crit. Care 2020; 28: 120-4.
49. Referans49. Fan E, Beitler JR, Brochard L, Calfee CS, Ferguson ND, Slutsky AS, et al. COVID-19-associated acute respiratory distress syndrome: is a different approach to management warranted?. The Lancet Resp Med 2020; 8(8): 816–21.
50. Referans50. Mart MF, Ware LB. The long-lasting effects of the acute respiratory distress syndrome. Expert review of respiratory medicine 2020; 14(6): 577-86.
51. Referans51. Ruhl AP, Huang M, Colantuoni E, Karmarkar T, Dinglas VD, Hopkins RO et al. Healthcare utilization and costs in ARDS survivors: a 1-year longitudinal national US multicenter study. Intens care med 2017;43(7): 980-91. Referans52. Herridge MS, Moss M, Hough CL, Hopkins RO, Rice TW, Bienvenu OJ, et al. Recovery and outcomes after the acute respiratory distress syndrome (ARDS) in patients and their family caregivers. Intensive care medicine 2016; 42(5): 725-38.