Introduction. The role of peptides in antinociceptive system regulation has became a subject of interest for scientists worldwide. The first registered peptide analgesic tyrosyl-D-arginyl-phenylalanyl-glycinamide acetate which currently can be used in clinical practice was developed in Russia under the name Taphalgin® (PharmFirma “Sotex”, Russia). The effectiveness and safety of this pharmaceutical in postoperative pain management was evaluated in the all-Russia multicenter prospective observation program NICITA (Non-interventional Clinical Trial of Taphalgin ®).Aim. To analyze the effectiveness and safety of Taphalgin® in postoperative pain management in various surgical fields.Materials and methods. The observational program NICITA included 887 patients including patients with malignant tumors of various locations from 15 study centers in different Russian cities. All patients underwent surgical interventions in various anatomical areas under general, regional and combination anesthesia. The principal scheme of postoperative pain management was based on the multimodal approach which included peptide opioid agonist alongside acetaminophen, cyclooxygenase inhibitors in combination with regional anesthesia or without it. The study also included patients who underwent small-volume surgeries, and pain was managed through Taphalgin® monotherapy with subsequent switch to cyclooxygenase inhibitors. The primary endpoint of the NICITA observational program was response to therapy after the first Taphalgin® administration. Decreased pain syndrome per the numerical rating scale 15–60 min after subcutaneous injection and maintenance of analgesic effect 3 h later were considered treatment response. The secondary endpoints included mean time to analgesia start after administration of the 1st single drug dose (in min), duration of effect, types and frequency of adverse reactions including serious in the central nervous system, pulmonary system, gastrointestinal tract developed during the observational program, as well as patient and research physician satisfaction with pain management. To evaluate the significance of pain intensity change at rest and in motion in time, analysis of variance with repeat measurements was used; for pairwise comparison of two time periods, Student’s t-test for dependent samples was used. The differences were considered significant at p = 0.05.Results. Statistically significant decrease in pain intensity in the total patient group was observed 15 minutes after Taphalgin® administration; it reached its minimum 40 min after the injection (р <0.05). The percentage of patients responding to analgesic therapy with Taphalgin® was 96.5 %. During administration of the drug, insignificant decrease (10–15 mmHg) in arterial blood pressure (1.7 % of cases) and vertigo (1 % of cases) were observed. In some patients, several adverse reactions were observed. Satisfaction with analgesic effect of Taphalgin® was relatively high both in patients and research physicians.Conclusion. Taphalgin® has pronounced analgesic effect and is effective for pain management after surgical interventions of various volumes and injury level. The use of this drug is associated with low rate of adverse reactions and absence of pulmonary depression characterizing opioid agonists. Therefore, Taphalgin® can be recommended for clinical use for postoperative pain management after various types of surgical interventions.

OBJECTIVE:To evaluate the efficacy and safety of using a fixed combination of diclofenac and orphenadrine for early postoperative pain relief in orthopedic patients following hip prosthetics.MATERIAL AND METHODS:A prospective comparative study enrolled 65 patients with primary total hip replacement in the setting of spinal bupivacaine anesthesia. Patients were divided into 2 groups - study (39 patients) and control (26 people). The study group underwent Neodolpasse infusion (orphenadrine 30 mg + diclofenac 75 mg) after the end of surgery and morphine infusion in a patient-controlled analgesia (PKA) regimen. The control group underwent morphine monotherapy in the PKA regimen. The intensity of pain syndrome was compared on a visual-analog scale (VAS) from 0 to 100, the total amount of morphine administered, the number of bolus requests, the change in kidney function and the side effect were assessed.RESULTS:In the control group, the duration of the intervention was shorter and amounted to 70 [59; 82] minutes, in the study group - 83 [65; 94] minutes (p=0.05). No significant difference was found in the number of bolus requests (32 [22; 38] and 23 [15; 36], p=0.085 and pain intensity 2 and 12 hours after the start of therapy (5 [4; 6] and 3 [2; 4] and 5 [4; 6] and 2 [2; 3] points) in the control group and in the study group. When assessing the intensity of pain syndrome 24 hours after the start of therapy, differences were found in the groups - in the control group 30 [2; 3] mm, in the study group 20 [2; 3] mm (p=0.05). There was no nephrotoxic effect on Neodolpasse. Complications of analgesic therapy in the form of nausea, vomiting, pruritus were recorded in both groups in equal amounts, which is explained by the administration of morphine in both groups.CONCLUSION:1. The use of a fixed combination of orphenadrine 30 mg + diclofenac 75 mg as part of postoperative pain relief after operations of primary hip prosthetics improves the quality of postoperative pain relief according to the subjective assessment of patients. 2. The use of a fixed combination of orphenadrine 30 mg + diclofenac 75 mg did not lead to the development of side effects and complications.

Введение. Анемия является распространённой проблемой у пациентов реанимации и интенсивной терапии. Причины анемий разнообразны и связаны не только с основным и сопутствующими заболеваниями, но и с ятрогенной кровопотерей, обусловленной частым и/или чрезмерным взятием крови для проведения лабораторных исследований. В условиях реани­мации у пациентов в критическом состоянии объем ежедневно отбираемой для исследования крови становится значимым фактором, способным влиять на исход заболевания. Поэтому у данной когорты пациентов актуальным является минимизация объёма и кратности отбора проб крови для выполнения необходимых лабораторных исследований. Цель исследования: оценить возможность минимизации объёма отбираемой крови и кратности отбора проб крови для лабораторных иссле­дований у реанимационных пациентов при использовании пробирок с уменьшенным объемом. Материалы и методы. Проведено одноцентровое, проспективное, открытое исследование. Все пациенты отделений реанимации были стратифицированы на 2 группы по временным интервалам по 10 дней каждый. Отбор проб венозной крови у группы 1 осуществляли в пробирки стандартного объема (BD Vacutainer); у группы 2 кровь отбирали в пробирки с уменьшенным объёмом (Sarstedt). Выполнены гематологические, биохимические, коагулогические лабораторные исследования, а также анализ газов и электролитов крови. Оценивали объёмы взятой крови, качество образцов крови и результаты исследований, полученных из пробирок двух типов. Результаты. При сравнении стандартных пробирок и пробирок с уменьшенным объемом достигнуто снижение на 41,8% объёма взятой на аналогичные исследования крови без потери качества и кратности исследования. Наиболее значительное снижение диагностических кровопотерь достигнуто в исследованиях газов и электролитов (на 58%) и в коагулологических исследованиях (на 48,1%). Кроме того, использование пробирок с уменьшенным объемом, адаптированных для реанимационных отделений, в сочетании с дополнительным обучением среднего медицинского персонала позволило снизить общее количество проб ненадлежащего качества с 37,13 до 9,77%. Заключение. Применение пробирок с уменьшенным объемом позволяет снизить долю проб ненадлежащего качества и сэкономить 41,8% объема крови, взятой на лабораторные исследования у реанимационных пациентов, что способствует профилактике ятрогенной анемии. Introduction. Anemia is a common issue in intensive care and critical care patients. The causes of anemia are diverse and are associated not only with underlying and concomitant diseases, but also with iatrogenic blood loss due to frequent and/or excessive blood sampling for laboratory tests. In intensive care in critically ill patients, the volume of blood taken daily for testing becomes a significant factor that can affect the outcome of the disease. Hence, minimizing volume and frequency of blood sampling becomes relevant for performing necessary laboratory tests in this cohort of patients. Aim: to evaluate the possibility of minimizing the volume of blood drawn and the frequency of blood sampling for laboratory tests in intensive care patients when using low-volume tubes. Materials and Methods. In a single center, prospective, open study, all patients in intensive care units were stratified into two groups at time intervals of 10 days each. Venous blood sampling from the first group was carried out in standard tubes (BD Vacutainer). In the second group, blood was collected in reduced-volume test tubes (Sarstedt). Hematological, biochemical, and coagulation laboratory tests, as well as analysis of gases and blood electrolytes were carried out. The volumes of blood taken, the quality of blood samples, and the test results obtained from test tubes of two types were evaluated. Results. When comparing standard tubes and tubes with a reduced volume, a 41.8% reduction in the volume of blood taken for the same tests was achieved, without loss of test quality and multiplicity. The most significant reduction in diagnostic blood loss was achieved in gas and electrolyte tests (by 58%) and tests coagulological tests (by 48.1%). In addition, the use of reduced-volume tubes adapted for intensive care units, combined with additional training for nurses, reduced the total number of samples of poor quality from 37.13 to 9.77%. Conclusion. The use of reduced-volume tubes reduces the proportion of samples of inadequate quality and saves 41.8% of the volume of blood taken for laboratory tests in intensive care patients, which contributes to more effective treatment and prevention of iatrogenic anemia.

The severe course of the new coronavirus infection (COVID-19) is associated with multiple life-threatening complications that lead to delayed initiation of active rehabilitation and unfavorable long-term treatment outcomes. Tracheoesophageal fistula is one of these complications. The specific feature of this event in COVID-19 is delayed tissue regeneration which requires a non-standard approach to management of such patients.The article presents a clinical case of a pregnant patient after a complicated severe course of COVID-19 with the development of tracheoesophageal fistula, sepsis, and weakness syndrome acquired in ICU. The combination of complications of the disease led to a prolonged (about five months) period of rehabilitation.Modern standard components of intensive therapy of such patients including regular monitoring of endotracheal/tracheostomy tube cuff pressure, dynamic assessment of nutritional status and its correction, rational antimicrobial therapy, screening of psychiatric disorders and early rehabilitation, will minimize the number of both early and delayed complications of COVID-19.

ЦЕЛЬ ИССЛЕДОВАНИЯ Определить частоту развития и структуру тромботических и геморрагических осложнений у пациентов с COVID-19 в отделении реанимации и интенсивной терапии (ОРИТ). МАТЕРИАЛ И МЕТОДЫ В ретроспективное исследование включили пациентов (n=442) с тяжелым и крайне тяжелым течением COVID-19, госпитализированных в ОРИТ. РЕЗУЛЬТАТЫ У 87 (19,7%) из 442 пациентов возникли тромботические осложнения, преимущественно представленные тромбозами в системе глубоких и поверхностных вен нижних конечностей (n=42; 9,5%). Артериальные тромботические осложнения развились у 34 (7,7%) пациентов. Ведущими в структуре данных осложнений были острое нарушение мозгового кровообращения (n=19; 4,3%) и инфаркт миокарда (n=11; 2,5%). Пациенты, у которых диагностированы тромботические осложнения, по сравнению с пациентами без тромботических осложнений чаще нуждались в респираторной терапии и введении норэпинефрина, имели большую продолжительность пребывания в ОРИТ и в стационаре. У пациентов с тромботическими осложнениями определены более высокие концентрации ферритина, С-реактивного белка и тропонина Т при поступлении в ОРИТ, чем у пациентов без тромботических осложнений. По данным тромбоэластографии, у пациентов с тромботическими осложнениями отмечен профиль гиперкоагуляции, но различия между группами статистически незначимые. Геморрагические осложнения диагностированы у 23 (5,2%) пациентов, из них у 15 возникли большие кровотечения. В структуре геморрагических осложнений преобладали желудочно-кишечные кровотечения. ЗАКЛЮЧЕНИЕ У пациентов с тяжелым и крайне тяжелым течением COVID-19 отмечена высокая частота тромботических и геморрагических осложнений. Необходимо провести проспективные рандомизированные исследования для определения риска/пользы применения различных режимов антикоагулянтной терапии у пациентов с новой коронавирусной инфекцией в ОРИТ.

Пандемия COVID-19 характеризуется волнообразным течением, а также изменением подходов к лечению. Анализ клинико-лабораторных данных и их динамики позволит изучить особенности данной категории больных. ЦЕЛЬ ИССЛЕДОВАНИЯ Сравнить клинико-лабораторные характеристики пациентов реанимационного профиля первой и второй волн пандемии COVID-19. МАТЕРИАЛ И МЕТОДЫ Представлены данные 543 пациентов, госпитализированных в отделение реанимации и интенсивной терапии (ОРИТ) в первую и вторую волны пандемии. РЕЗУЛЬТАТЫ Сроки поступления пациентов в ОРИТ в первую волну были меньше, чем во вторую: от начала заболевания 10 [7; 13] и 11 [9; 17] дней, от поступления в стационар 2,5 [0; 5] и 4 [2; 8] дня соответственно. Пациенты второй волны были старше (74 [64; 82] и 68 [57; 79] лет, p=0,001). Длительность искусственной вентиляции легких (10 [5; 15] и 4 [1; 7] дня) была меньше во вторую волну; применение галоперидола (29,5 и 38,8%), глюкокортикостероидов (23 и 88,9%) отмечено чаще во вторую волну. Гемодиализ чаще проводили в первую волну (17,5 и 8,4%). Из лабораторных показателей выявлены различия между пациентами двух волн по числу лейкоцитов (p=0,001), тромбоцитов (p=0,025), нейтрофильно-лимфоцитарному соотношению (p=0,001), креатинину (p=0,043), С-реактивному белку (p=0,01), прокальцитонину (p=0,001). Во вторую волну длительность пребывания в ОРИТ была меньше (8 [4; 15] и 6 [3; 10] дней, p=0,003), а летальность больше (101 (50,5%) и 215 (62,7%), p=0,006). ЗАКЛЮЧЕНИЕ Длительность лечения в амбулаторных и стационарных условиях увеличилась, что привело к позднему поступлению пациентов в отделение реанимации и интенсивной терапии. Изменились подходы к респираторной и медикаментозной терапии. Средний возраст пациентов во вторую волну был больше с соответствующим увеличением летальности с каждым десятилетием.

The aim of the study was to determine the etiology and frequency of nosocomial infections in patients with severe and critical COVID-19.Material and methods. A retrospective, single-center study included 168 patients with COVID-19 admitted to the intensive care unit (ICU). All episodes of infection, clinical and laboratory characteristics, and outcome were documented in patients.Results. Hospital-acquired infections were detected in 82 (48.8%) of 168 patients, more frequently in men (p = 0.028). A total of 232 episodes of nosocomial infections were observed including ventilator-associated pneumonia (48.2%), bloodstream infection (39.2%), nosocomial pneumonia/tracheobronchitis (13.4%), and urinary tract infection (5.2%). The main causative agents of nosocomial infections were resistant strains of Acinetobacter baumannii and Klebsiella pneumoniae. Infections developed on the average on day 6 [3; 9] of ICU stay and were associated with the initial severity of the patients assessed by SOFA (p=0.016), SpO2 (p=0.005), lymphopenia severity (p=0.003), Neutrophil-Lymphocyte Ratio (p=0.004), C-reactive protein (p=0.01), aspartate aminotransferase (AST) level (p=0.022), or vitamin D (p=0.035) levels. Patients diagnosed with infection were more likely than those without infections to require mechanical ventilation (67.6% vs 32.4%, p < 0.001), high-flow oxygen therapy (50.0% vs 31.0%, p = 0.020), renal replacement therapy (36.8% vs 9.3%, p = 0.003), and had longer ICU length of stay (13 [9; 18] vs 4 [2; 8], p < 0.001), hospital length of stay (19 [14; 29] vs 15 [11; 20], p = 0.001) and mortality (47 (57.3%) vs 25 (29.0%), p < 0.001).Conclusion. In patients with severe and critical COVID-19 a high incidence of nosocomial infections was found, which negatively affected the outcome. In more than half of the cases, the infection was caused by resistant strains of Gram-negative bacilli. Procalcitonin is a useful biomarker for identifying bacterial infection in patients with COVID-19.

The aim of the study was to assess regional cerebral oxygenation (rScO₂) in patients with acute respiratory distress syndrome (ARDS) associated with COVID-19.Material and methods. The cross-sectional study was conducted. Twenty-eight patients with severe COVID-19 who were admitted in the intensive care unit were enrolled. Regional cerebral oxygenation was assessed using near-infrared spectroscopy, laboratory markers of cerebral damage, clinical and laboratory characteristics.Results. Median age of patients was 65 years, of whom 50% were men. Three (11%) patients had severeARDS, 8 (29%) patients had moderate ARDS, and 17 (60%) patients had mild ARDS. Mechanical ventilation was performed in 20 (71%) patients, vasopressors were used in 14 (50%) patients. The median levels of cerebral saturation were normal and did not differ between the left (rScO₂l) and right (rScO₂r) hemispheres (68 (58–75) and 69 (59–76), respectively). The level of S-100 protein was increased (0.133 (0.061–0.318) µg/l) in contrast to the normal level of neuron-specific enolase (12.5 (8.0–16.5) µg/l). A correlation was found only between rScO₂ and hemoglobin level (rho=0.437, P=0.02) and between rScO₂ and lymphocyte count (rho=–0.449, P=0.016). An increase in S-100 negatively correlated with a decrease in Glasgow Coma Scale score (rho=–0.478, P=0.028).Conclusion. Near-infrared spectroscopy did not reveal a decrease in rScO₂ among patients with ARDS associated with COVID-19. The S-100 protein is a useful marker for the assessment of impaired consciousness. Further study of the causes of cerebral dysfunction in patients with severe COVID-19 and methods for its early identification is warranted.

Objective. To analyze the incidence and predictors of venous thromboembolic complications (VTEC) in COVID-19 patients ad-mitted to intensive care unit (ICU). Material and methods. A retrospective study recruited 200 ICU patients presenting with severe or critical COVID-19. Results. VTEC were found in 67 (33.5%) out of 200 patients. In 63 patients, deep and superficial vein thrombosis was observed. Four patients had pulmonary embolism. In 41 (20.5%) patients, VTEC occurred within the first day after admission to ICU. Patients presenting with VTEC had more extensive lung damage (CT data) and more common need for vasopressors (79.1% vs 59.4%, p=0.005) and mechanical ventilation (89.6% vs 60.2%, p=0.0001). Survival of these patients was lower (23 (34.3%) vs 76 (57.1%), p=0.003). There were significant differences in levels of von Willebrand factor antigen (vWF: Ag), interleukin 6 (IL-6), antithrombin III (AT III) and protein C. According to ROC analysis, vWF: Ag above 455% (AUC — 0.852 (0.69;1.00), p=0.008) was highly predictive for the risk of VTEC after 1 and 7 days. AT III below 72% (AUC — 0.77 (0.55;0.99), p=0.04) and IL-6 above 256 pg/ml (AUC — 0.85 (0.65;1.00), p=0.053) were prognostic factors of VTEC after the first day. Protein C below 81.5% at admission (AUC — 0.79 (0.59-0.99), p=0.042) was predictive regarding VTEC by the seventh day. Conclusion. Incidence of VTEC in ICU patients was 33.5%. In 60% of patients, VTEC developed before admission to ICU. vWF: Ag, AT III, IL-6, and protein C serve as predictors of VTEC in patients with severe or critical COVID-19. © 2021, Media Sphera Publishing Group. All rights reserved.

Introduction. Currently, there are no universal criteria for assessing the volume of predicted functional recovery of patients during rehabilitation in intensive care units. Objective. To identify independent predictors of efficiency of rehabilitation of patients after a critical illness. Materials and methods. The study was conducted on the basis of a general ICU in 2017–2019. Patients with a short course of rehabilitation (≤ 7 days), deep impairment of consciousness (≤ 7 points on the Glasgow coma scale), decompensated multiple organ failure were excluded from the study. Clinical and laboratory data of 82 patients were retrospectively analyzed, including baseline severity of the condition, degree of functional independence and mobility, assessment of neurological deficit, incidence of depression and delirium, duration of mechanical ventilation and terms of hospitalization. We used a calculated indicator to analyze the effectiveness of rehabilitation — the rehabilitation potential index (RPI). Patients were assigned to the group of effective rehabilitation (ER) or ineffective rehabilitation (IR) depending on the level of RPI. Results. The duration of mechanical ventilation, the frequency of impaired consciousness and the duration of hospitalization were higher in the IR group than in the ER group. Сonsciousness impairment was found to be an independent predictor of low efficacy of the rehabilitation (odds ratio 4.53; confidence interval 95 % 1.63–12.6; p < 0.05). Conclusions. RPI can be used as a tool for assessing the effectiveness of rehabilitation of patients after a critical illness. The duration of mechanical ventilation has a negative effect on the functional outcome at discharge from the intensive care unit. The initial level of consciousness can be a benchmark for predicting the effectiveness of rehabilitation. Further prospective studies are needed to identify predictors of the effectiveness of early rehabilitation.

Актуальность. В настоящее время не существует универсальных критериев определения объема прогнозируемого функционального восстановления пациентов при проведении реабилитации в отделениях интенсивной терапии. Цель исследования. Выявить независимые предикторы эффективности реабилитации пациентов после перенесенного критического состояния. Материалы и методы. Исследование проведено на базе многопрофильного отделения реанимации в 2017–2019 гг. Пациенты с коротким курсом реабилитации (≤ 7 суток), глубоким нарушением сознания (≤ 7 баллов по шкале комы Глазго), декомпенсированной полиорганной недостаточностью были исключены из исследования. Ретроспективно проанализированы клинико-лабораторные данные 82 пациентов, включая исходную тяжесть состояния, степень функциональной независимости и мобильности, оценку неврологического дефицита, частоту депрессии и делирия, длительность респираторной поддержки и сроки госпитализации. Для анализа эффективности реабилитации использован расчетный показатель — индекс реабилитационного потенциала (ИРП). В зависимости от уровня ИРП пациенты были отнесены к группе эффективной реабилитации (ЭР) либо малоэффективной реабилитации (МР). Результаты. Длительность искусственной вентиляции легких, частота нарушения сознания и продолжительность госпитализации были выше в группе МР, чем в группе ЭР. Нарушение сознания явилось независимым предиктором низкой эффективности проводимой реабилитации (отношение шансов — 4,53; 95%-й доверительный интервал 1,63–12,6; p < 0,05). Выводы. ИРП может использоваться как инструмент оценки результативности реабилитации пациентов после перенесенного критического состояния. Продолжительность искусственной вентиляции легких оказывает негативное влияние на функциональный исход при выписке из отделения реанимации и интенсивной терапии. Исходный уровень сознания может быть ориентиром для прогнозирования эффективности проводимой реабилитации. Необходимо дальнейшее проведение проспективного исследования для выявления предикторов эффективности ранней реабилитации.

The article presents a comparative retrospective analysis of clinical, laboratory data and outcomes in 39 patients with severe COVID-19 complicated by acute respiratory distress syndrome, who received high-flow oxygen therapy. Of which, 19 patients additionally received 75 mg of inhaled surfactant BL twice daily for 5 days using a nebulizer. As a result, mortality rate in the group of patients receiving surfactant was 10.5%, while in the standard therapy group — 50%; the number of patients transferred to the mechanical ventilation was 21% and 70%, respectively. As the patients receiving the surfactant were injected with COVID-19 hyperimmune convalescent plasma and monoclonal antibodies to interleukin-6 receptors more often than those from the control group, we recalculated the results regardless of these patients. However, a significant difference between the mechanical ventilation rate (2.5 times less often in the surfactant group) and mortality rate (3.5 times less in the surfactant group) was observed. The duration of hospitalization and stay at the intensive care unit was not significantly different between patients with and without surfactant treatment. Inhalation therapy with surfactant BL was well tolerated even by patients with chronic obstructive pulmonary disease. In no case did therapy have to be stopped due to side effects, the most common of which was coughing during inhalation. This retrospective analysis shows that the prescription of an inhaled surfactant prior to transferring patients to mechanical ventilation can prevent the progression of respiratory failure, put down mechanical ventilation, and improve survival.

Introduction. The lack of effective aetiotropic therapy of COVID-19 prompted researchers around the world searching for various methods of SARS-CoV-2 elimination, including convalescent plasma. The aim of this work was to study the safety and efficacy of severe COVID-19 treatment with convalescence plasma containing specific antibodies to the receptor binding domain (RBD) of SARS-CoV-2 S protein in a titer of at least 1: 1000. Methods. A single-center, randomized, prospective, clinical study performed at the FRCC FMBA of Russia with the participation of 85 patients who were stratified in two groups. The first group contains 20 critically ill patients who are on mechanical ventilation; Results. The use of plasma of convalescents in patients with severe COVID-19 with mechanical ventilation does not affect the disease outcome in these patients. Mortality rate in this group was 60%, which corresponds to the average mortality of patients on mechanical ventilation in our hospital. In the second group clinical improvement was detected in 75% and 51%, for convalescent and normal plasma respectively. Of the 46 people who received convalescent plasma, three patients (6.5%) were transferred to mechanical ventilation, two of whom died. In the group receiving non-immune plasma, the need for mechanical ventilation also arose in three patients (15%), of which two died. The hospital mortality in the group of convalescent plasma was 4.3%, which is significantly lower than the average COVID-19 hospital mortality in our Center (6.73%) and more than two times lower than the hospital mortality in the control group (n = 150), matched by age and by the disease severity. Conclusions. Thus, we demonstrated relative safety of convalescent plasma transfusion and the effectiveness of such therapy for COVID-19 at least in terms of the survival of patients with severe respiratory failure without mechanical ventilation. In the absence of bioengineered neutralizing antibodies and effective aetiotropic therapy, the use of hyperimmune convalescent plasma is the simplest and most effective method of specific etiopathogenetic therapy using forms of COVID-19.

The article presents a comparative retrospective analysis of clinical, laboratory data and outcomes in 39 patients with severe COVID-19 complicated by acute respiratory distress syndrome, who received high-flow oxygen therapy. Of which, 19 patients additionally received 75 mg of inhaled surfactant BL twice daily for 5 days using a nebulizer. As a result, mortality rate in the group of patients receiving surfactant was 10.5%, while in the standard therapy group — 50%; the number of patients transferred to the mechanical ventilation was 21% and 70%, respectively. As the patients receiving the surfactant were injected with COVID-19 hyperimmune convalescent plasma and monoclonal antibodies to interleukin-6 receptors more often than those from the control group, we recalculated the results regardless of these patients. However, a significant difference between the mechanical ventilation rate (2.5 times less often in the surfactant group) and mortality rate (3.5 times less in the surfactant group) was observed. The duration of hospitalization and stay at the intensive care unit was not significantly different between patients with and without surfactant treatment. Inhalation therapy with surfactant BL was well tolerated even by patients with chronic obstructive pulmonary disease. In no case did therapy have to be stopped due to side effects, the most common of which was coughing during inhalation. This retrospective analysis shows that the prescription of an inhaled surfactant prior to transferring patients to mechanical ventilation can prevent the progression of respiratory failure, put down mechanical ventilation, and improve survival.