Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

Prometnoy D.V.; Aleksandrovich Yu.S.; Mironov P.I.; Pshenisnov K.V.; Anchutin P.E.; Ivanilova A.A.

doi:https://doi.org/10.17116/anaesthesiology202204178

Prometnoy D.V.

Russian Children’s Clinical Hospital of the Pirogov Russian National Research Medical University

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Mironov P.I.

Bashkir State Medical University

ORCID: 0000-0002-9016-9461

Pshenisnov K.V.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Anchutin P.E.

Pirogov Russian National Research Medical University

Ivanilova A.A.

Saint-Petersburg State Pediatric Medical University

Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children

Authors:

Prometnoy D.V., Aleksandrovich Yu.S., Mironov P.I., Pshenisnov K.V., Anchutin P.E., Ivanilova A.A.

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Journal: Russian Journal of Anesthesiology and Reanimatology. 2022;(4): 78‑84

DOI: 10.17116/anaesthesiology202204178

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To cite this article:

Prometnoy DV, Aleksandrovich YuS, Mironov PI, Pshenisnov KV, Anchutin PE, Ivanilova AA. Efficacy of clinical guidelines in the treatment of severe forms of a novel coronavirus infection in children. Russian Journal of Anesthesiology and Reanimatology. 2022;(4):78‑84. (In Russ.)
https://doi.org/10.17116/anaesthesiology202204178

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Abstract:

Intensive therapy of severe COVID-19 is one of the most difficult problems of modern intensive care.

OBJECTIVE

To assess the effectiveness of clinical guidelines in the treatment of severe forms of a new coronavirus infection in children.

MATERIAL AND METHODS

A retrospective controlled non-randomized multiple-center study enrolled 111 ICU children from 40 hospitals. Specialists of the Federal Remote Intensive Care Counselling Centre counseled all patients. Children were divided into 2 groups («recovery» and «death») depending on the outcome.

RESULTS

PSOFA score 2 (1—5) at admission was associated with 19.5-fold increase of mortality risk (OR 19.5, 95% CI 2.3—165.7). We found higher score «respiratory distress» item in all patients regardless the outcome. Antibacterial, corticosteroid therapy and vasopressor support significantly affected the outcome of disease (χ²=18.202; df=3, p=0.000), while infusion, respiratory, anticoagulant therapy and enteral nutrition were less significant, especially in pSOFA score ≤4 points (χ²=15.521; df=5, p=0.008). Mortality risk decreased in no need for increase of initial doses of catecholamines (OR 0.2, 95% CI=0.1—0.7). Less compliance with recommendations for correction of antibacterial and corticosteroid therapy was followed by higher mortality (OR 5.2, 95% CI 1.4—18.9 and OR 3.4, 95% CI 1.1—10.8, respectively).

CONCLUSION

Timely strict implementation of clinical guidelines, adequate catecholamine support, antibacterial and corticosteroid therapy in children with COVID-19 significantly reduce the likelihood of mortality.

Keywords:

new coronavirus infection

intensive care

efficacy

pSOFA

outcome

children

Authors:

Prometnoy D.V.

Russian Children’s Clinical Hospital of the Pirogov Russian National Research Medical University

Aleksandrovich Yu.S.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0002-2131-4813

Mironov P.I.

Bashkir State Medical University

ORCID: 0000-0002-9016-9461

Pshenisnov K.V.

Children’s Scientific Clinical Center for Infectious Diseases

ORCID: 0000-0003-1113-5296

Anchutin P.E.

Pirogov Russian National Research Medical University

Ivanilova A.A.

Saint-Petersburg State Pediatric Medical University

Received:

01.01.2022

Accepted:

08.02.2022

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References:

Chowdhury R, Khan H, Heydon E, Shroufi A, Fahimi S, Moore C, Stricker B, Mendis S, Hofman A, Mant J, Franco OH. Adherence to cardiovascular therapy: a meta-analysis of prevalence and clinical consequences. European Heart Journal. 2013;34(38):2940-2948. https://doi.org/10.1093/eurheartj/eht295
Zabolotskikh IB, Belkin AA, Butrov AV, Kondratiev AN, Lebedinsky KM, Lubnin AYu, Magomedov MA, Nikolaenko EM, Ovechkin AM, Shifman EM, Schegolev AV. Perioperative management of patients with neuromuscular diseases. Anesteziologiya i reanimatologiya. 2019;1:6-26. (In Russ.). https://doi.org/10.17116/anaesthesiology20190116
Leyderman IN, Gritsan AI, Zabolotskikh IB, Krilov KYu, Lebedinsky KM, Mazurok VA, Nikolaenko EM, Yaroshetsky AI. Metabolic monitoring and nutritional support in prolonged mechanically ventilated (MV) patients. Clinical guidelines. Anesteziologiya i reanimatologiya. 2019;4:5-19. (In Russ.). https://doi.org/10.17116/anaesthesiology20190415
World Health Organization. Adherence to long-term therapies: evidence for action. WHO Library Cataloguing-in-Publication Data, Geneva, WHO; 2003.
Aleksandrovich YuS, Gordeev VI. Ocenochnye i prognosticheskie shkaly v medicine kriticheskih sostoyanij. SPb.: ELBI-SPb; 2015. (In Russ.).
Kessler DO, Walsh B, Whitfill T, Dudas RA, Gangadharan S, Gawel M, Brown L, Auerbach M; INSPIRE ImPACTS investigators. Disparities in Adherence to Pediatric Sepsis Guidelines across a Spectrum of Emergency Departments: A multicenter, cross-sectional observational in situ simulation study. The Journal of Emergency Medicine. 2016;50(3):403-415.e1-3. https://doi.org/10.1016/j.jemermed.2015.08.004
McColl T, Gatien M, Calder L, Yadav K, Tam R, Ong M, Taljaard M, Stiell I. Implementation of an Emergency Department Sepsis Bundle and System Redesign: A Process Improvement Initiative. CJEM. 2017;19(2):112-121. https://doi.org/10.1017/cem.2016.351
Rodrigues-Santos G, de Magalhães-Barbosa MC, Raymundo CE, Lima-Setta F, da Cunha AJLA, Prata-Barbosa A. Improvement of 1st-hour bundle compliance and sepsis mortality in pediatrics after the implementation of the surviving sepsis campaign guidelines. Jornal de Pediatria. 2021;97(4):459-467. https://doi.org/10.1016/j.jped.2020.09.005
O’Lynnger TM, Shannon CN, Le TM, Greeno A, Chung D, Lamb FS, Wellons JC 3rd. Standardizing ICU management of pediatric traumatic brain injury is associated with improved outcomes at discharge. Journal of Neurosurgery. Pediatrics. 2016;17(1):19-26. https://doi.org/10.3171/2015.5.PEDS1544
Shabalov NP, Aleksandrovich YuS. Eduard Kuzmich Tsybul’kin the founder of critical and emergency care for children in Leningrad — Saint Petersburg (The 80th anniversary of his birth). Pediatr. 2018;9(5):131-138. (In Russ.).
Aleksandrovich YuS, Pshenisnov KV, Parshin YeV, Cherevatenko RI, Gordeyev VI. Role of intensive care consulting centers in reducing infantile mortality. Anesteziologiya i reanimatologiya. 2009;1:48-51. (In Russ.).
Yunusov DI, Pshenisnov KV, Mironov PI, Aleksandrovich YuS. The role of resuscitation consultant centre in optimization of treatment of severe trauma in children. Skoraya medicinskaya pomoshch’. 2016;17(1):15-19. (In Russ.). https://doi.org/10.24884/2072-6716-2016-17-1-15-19
Alexandrovich YuS, Alekseeva EI, Bakradze MD, Baranov AA, Batysheva TT, Vashakmadze ND, Vershinina MG, Vishneva EA, Glazyrina AA, Gordeeva OB, Dyakonova EYu, Zholobova ES, Zabolotskyy DV, Zvereva NN, Zelenkova IV, Ivanov DO, Kaytukova EV, Karkashadze GA, Konovalov IV, Kruchko DS, Kulichenko TV, Kurbanova SKh, Levina YuG, Lobzin YuV, Mazankova LN, Margieva TV, Namazova-Baranova LS, Novikova YuYu, Ovsyannikov DYu, Petryaykina EE, Petrenko YuV, Petrova NV, Prometnoy DV, Pshenisnov KV, Revunenkov GV, Rtishchev AYu, Rusinova DS, Sayfullin MA, Sayfullin RF, Selimzyanova LR, Tatochenko VK, Tepaev RF, Uskov AN, Fedoseenko MV, Fisenko AP, Khar’kin AV, Efendieva KE, Yakovlev AV. Clinical features and management of the disease caused by new coronaviral infection (COVID-19) in children. Version 2. Pediatricheskaya farmakologiya. 2020;17(3):187-212. (In Russ.). https://doi.org/10.15690/pf.v17i3.2123
Profilaktika, diagnostika i lechenie novoj koronavirusnoj infekcii (COVID-19). Vremennye metodicheskie rekomendacii. Versija 13.1 ot 17.11.2021. M.: Izd-vo Ministerstva zdravoohranenija RF; 2021. (In Russ.).
Plevinsky JM, Young MA, Carmody JK, Durkin LK, Gamwell KL, Klages KL, Ghosh S, Hommel KA. The impact of COVID-19 on pediatric adherence and self-management. Journal of Pediatric Psychology. 2020;45(9):977-982. https://doi.org/10.1093/jpepsy/jsaa079
Aleksandrovich YuS, Prometnoy DV, Mironov PI, Pshenisnov KV, Tepluakova ED Predictors of death in severe new coronavirus infection COVID-19 in children, Vestnik anesteziologii i reanimatologii. 2021;18(4):29-36. (In Russ). https://doi.org/10.21292/2078-5658-2021-18-4-29-36

Palmer BF, Clegg DJ. Electrolyte Disturbances in Chronic Alcohol-Use Disorder. N Engl J Med. 2018;378(2):203-204. https://doi.org/10.1056/NEJMc1714331

Broeren MA, Geerdink EA, Vader HL, van den Wall Bake AW. Hypomagnesemia induced by several proton-pump inhibitors [published correction appears in Ann Intern Med. 2010;152(4):268]. Ann Intern Med. 2009;151(10):755-756. https://doi.org/10.7326/0003-4819-151-10-200911170-00016

Park CH, Kim EH, Roh YH, Kim HY, Lee SK. The association between the use of proton pump inhibitors and the risk of hypomagnesemia: a systematic review and meta-analysis. PLoS One. 2014;9(11):e112558. Published 2014 Nov 13. https://doi.org/10.1371/journal.pone.0112558

Cheungpasitporn W, Thongprayoon C, Kittanamongkolchai W, et al. Proton pump inhibitors linked to hypomagnesemia: a systematic review and meta-analysis of observational studies. Ren Fail. 2015;37(7):1237-1241. https://doi.org/10.3109/0886022X.2015.1057800

FDA drug safety communication: low magnesium levels can be associated with long-term use of Proton Pump Inhibitor drugs (PPIs). Silver Spring, MD: Food and Drug Administration, March 2, 2011. https://www.fda.gov/drugs/drugsafety/ucm245011.htm

Palmer BF. Diagnostic approach and management of inpatient hyponatremia. J Hosp Med. 2010;5(suppl 3):1-7. https://doi.org/10.1002/jhm.702

Achinger SG, Ayus JC. Electrolyte Disturbances in Chronic Alcohol-Use Disorder. N Engl J Med. 2018;378(2):202-203. https://doi.org/10.1056/NEJMc1714331

Sterns RH, Silver SM. Complications and management of hyponatremia. Curr Opin Nephrol Hypertens. 2016;25(2):114-119. https://doi.org/10.1097/MNH.0000000000000200

Sanghvi SR, Kellerman PS, Nanovic L. Beer potomania: an unusual cause of hyponatremia at high risk of complications from rapid correction. Am J Kidney Dis. 2007;50(4):673-680. https://doi.org/10.1053/j.ajkd.2007.07.015

Bähr M, Sommer N, Petersen D, Wiethölter H, Dichgans J. Central pontine myelinolysis associated with low potassium levels in alcoholism. J Neurol. 1990;237(4):275-276. https://doi.org/10.1007/BF00314635

Falcone N, Compagnoni A, Meschini C, Perrone C, Nappo A. Central pontine myelinolysis induced by hypophosphatemia following Wernicke’s encephalopathy. Neurol Sci. 2004;24(6):407-410. https://doi.org/10.1007/s10072-003-0197-9

Ayus JC, Armstrong D, Arieff AI. Hyponatremia with hypoxia: effects on brain adaptation, perfusion, and histology in rodents. Kidney Int. 2006;69(8):1319-1325. https://doi.org/10.1038/sj.ki.5000187

Sterns RH. Disorders of plasma sodium--causes, consequences, and correction. N Engl J Med. 2015;372(1):55-65. https://doi.org/10.1056/NEJMra1404489