Shchudro O. Dyspnea in the subacute period of COVID-19: diagnostic algorithm and respiratory management

Українська версія

Thesis for the degree of Doctor of Philosophy (PhD)

State registration number

0824U001751

Thesis Registration Form

0824U001751.pdf

Applicant for

Specialization

  • 222 - Медицина

Specialized Academic Board

ДФ 08.601.110

Dnipro State Medical University

Essay

The dissertation is dedicated to an important scientific problem - the development of an algorithm for managing patients with dyspnea in the subacute period of coronavirus disease (COVID-19), which has developed due to respiratory and/or cardiovascular system involvement, taking into account the severity of the acute phase of the disease and improving respiratory management of patients. 116 patients with dyspnea in the subacute period of COVID-19 were examined (at 49 (44; 59) days from the onset of the first symptoms of the disease), who had non-hospital pneumonia associated with COVID-19 from April to November 2021. 14 patients were excluded due to the presence of comorbidities that could be the cause of dyspnea in the post-COVID period. Thus, a group of 102 patients was formed (average age - 58 (50; 62) years, males – 49 (48.0%), females – 53 (52.0%)), which was divided into three subgroups depending on the severity of COVID-19 in the acute period: subgroup 1 included 41 patients after a moderate-to-severe course, subgroup 2 – 46 patients after a severe course, and subgroup 3 – 15 patients after a critical course of the acute phase of the disease. The subgroups of patients were comparable in terms of age and gender. The novelty of the research and the obtained results. For the first time, types of ventilation disorders in patients with dyspnea in the subacute period of COVID-19 were determined in the absence of comorbid respiratory pathology and depending on the severity of the acute phase of the coronavirus disease. The mechanism of impaired lung diffusion capacity in patients with dyspnea in the subacute period of COVID-19 was identified for the first time depending on the severity of the acute phase of the disease. The diagnostic significance of serum SP-A level for assessing the condition of the surfactant system in patients with dyspnea in the subacute period of COVID-19 was established for the first time. The correlation between serum SP-A level and reduced lung diffusion capacity in patients with dyspnea in the subacute period of COVID-19 was determined for the first time depending on the severity of the acute phase of the disease. The contribution of pathological changes in the cardiovascular system to the formation of dyspnea in patients in the subacute period of COVID-19 in the absence of severe cardiovascular pathology in the anamnesis depending on the severity of the acute phase of the disease was determined for the first time. The diagnostic significance of NT-proBNP marker for determining cardiac dysfunction in patients with dyspnea in the subacute period of COVID-19 in the absence of severe cardiovascular pathology in the anamnesis depending on the severity of the acute phase of the disease was established for the first time. The main pathological mechanisms of dyspnea in patients in the subacute period of COVID-19 due to respiratory and/or cardiovascular system involvement depending on the severity of the acute phase of the disease were determined for the first time. The algorithm for providing medical care to patients with dyspnea in the subacute period of COVID-19 was developed for the first time. The theoretical and practical value of the work. The developed algorithm for managing patients with dyspnea in the subacute period of COVID-19, which developed due to respiratory and/or cardiovascular system involvement, taking into account the severity of the acute phase of the disease, and the proposed respiratory management of patients.

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Research papers

1. Перцева ТО, Конопкіна ЛІ, Бєлослудцева КО, Щудро ОО, Фуголь КВ. Вентиляційні та дифузійні порушення у осіб, що перенесли негоспітальну пневмонію, асоційовану з коронавірусною хворобою (COVID-19). Можливості інгаляційної терапії. Астма та Алергія. 2021;4:27-42.

2. Конопкіна ЛІ, Ботвінікова ЛА, Бєлослудцева КО, Щудро ОО. Вентиляційна функція легень в осіб, які перенесли пневмонію на тлі коронавірусної хвороби (COVID-19): діагностична значущість показників. Медичні перспективи. 2022;27(2):51-7

3. Конопкіна ЛІ, Щудро ОО. Роль дисфункції сурфактантної системи у формуванні задишки у хворих, які перенесли пневмонію, асоційовану з COVID-19. Інфузія & Хіміотерапія. 2023;2:7-12.

4. Конопкіна ЛІ, Щудро ОО. Стан серцево-судинної системи у хворих із задишкою, які перенесли пневмонію, асоційовану з COVID-19. Український пульмонологічний журнал. 2023;4:14-18.

5. Конопкіна ЛІ, Щудро ОО. Функціональний стан дихальної системи у хворих із задишкою, які перенесли негоспітальну пневмонію, асоційовану з COVID-19. Астма та алергія. 2023;4:21-30

6. Дудля АГ, Саніна НА, Щудро ОО. Постковідний синдром. В: Теврдохліб ІВ, Бондаренко НС, редактори. Новини і перспективи медичної науки: збірник матеріалів ХХІІ конференції студентів та молодих учених. Дніпро; 2022, с. 69-73

7. Pertseva T, Konopkina L, Myronenko O, Shchudro O. The dynamics of dyspnea in patients with pneumonia associated with SARS-CoV-2 infection. Eur Respir J. 2021;58(65):PA3315

8. Shchudro O, Bielosludtseva K, Pertseva T, Konopkina L, Krykhtina M. The role of spirometry and carbon monoxide diffusing capacity (DLCO) in diagnosing pulmonary function in patients post-COVID-19 pneumonia. Eur Respir J. 2021;58(65):PA611

9. Shchudro O, Bielosludtseva K, Pertseva T, Konopkina L, Krykhtina M, Konopkina L. Carbon monoxide diffusing capacity (DLCO) in COVID-19 survivors compared to idiopathic pulmonary fibrosis (IPF): pathogenetic features. Eur Respir J. 2021 Sep;58(Suppl 65):PA3900.

10. Konopkina L, Bielosludtseva K, Shchudro O. Dyspnea in COVID-19 survivors: carbon monoxide diffusing capacity (DLCO) test reveals the real truth: abstract. In: 5th Int Conf COVID-19 Stud. 2021, p. 418

11. Щудро ОО, Бєлослудцева КО, Губа ЮВ, Коваль ДС, Крихтіна МА. Легенева гіпертензія у пацієнтів, які перенесли пневмонію, асоційовану з COVID-19. В: Актуальні питання клінічної медицини: матеріали XI Всеукраїнської науково-практичної конференції молодих вчених з міжнародною участю; 2021 Листоп 19; Запоріжжя. Запоріжжя: ЗМАПО; 2021, с. 343.

12. Shchudro O, Konopkina L, Bielosludtseva K. The role of surfactant protein A in patients discharged after COVID-19 pneumonia. In: 32nd ECCMID, Lisbon, Portugal; 2022 Apr 23-26 [Internet]. 2022 [cited 2024 Feb 20]. L0387

13. Shchudro O, Konopkina L, Pertseva T, Botvinikova L, Bielosludtseva K. The role of NT-proBNP in patients discharged after COVID-19 pneumonia. Eur J Cardiovasc Nurs. 2022 Jul;21(Suppl 1):zvac060.019

14. Shchudro O, Konopkina L. Surfactant protein-A (SP-A) is a novel marker of lung disorders in patients discharged after COVID-19 pneumonia. Eur Respir J. 2022;60:1953

15. Krykhtina M, Bielosludtseva K, Konopkina L, Botvinikova L, Shchudro O. Influence of lung impairment on onset of pulmonary hypertension in patients with COVID-19-associated pneumonia. Eur Respir J. 2022;60:2347

16. Krykhtina M, Bielosludtseva K, Shchudro O, Konopkina L. Comparison of cardiac biomarkers predictive role in COVID-19 pneumonia. Eur Respir J. 2022;60:2880

17. Konopkina LI, Shchudro OO, Bielosludtseva KO, Myronenko OV. The association between diffusing ability of lung and onset of arrhythmias in the early post-COVID-19 period. Ukr Kardiol Zh. 2022;29(Suppl 1):63

18. Shchudro O, Konopkina L, Botvinikova L. Surfactant protein A (SP-A) as a predictor of hospital readmission in patients with dyspnea after COVID-19-associated pneumonia. In: 33nd ECCMID; Copenhagen, Denmark; 2023 Apr 15-18 [Internet]. 2023 [cited 2024 Feb 20]. P2533

19. Перцева ТО, Конопкіна ЛІ, Бондаренко ОО, Щудро ОО, Рибалка КВ, Габшидзе НО. Морфологічні аспекти ураження дихальної системи при COVID-19: аналіз аутопсійного матеріалу. В: Механізми розвитку патологічних процесів і хвороб та їх фармакологічна корекція: матеріали VІ науково-практичної інтернет-конференції з міжнародною участю; 2023 Листоп 16; Харків. Харків: НФаУ; 2023, с. 509

20. Shchudro O, Konopkina L. Dynamic evaluation of dyspnea in patients recovering from COVID-19 pneumonia: effects of acute illness severity. In: Innovative scientific research. Proceedings of the IX International Scientific and Practical Conference; Toronto, Canada. 2024, р. 56-57

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