Division of Pulmonary and Critical Care Medicine, Eastern Virginia Medical School , Norfolk, VA, USA.
Trauma and Life Support Center, Critical Care Service, University of Wisconsin School of Medicine and Public Health , Madison, WI, USA.
Expert Rev Anti Infect Ther. 2021 Feb;19(2):129-135. doi: 10.1080/14787210.2020.1808462. Epub 2020 Aug 18.
COVID-19 disease progresses through a number of distinct phases. The management of each phase is unique and specific. The pulmonary phase of COVID-19 is characterized by an organizing pneumonia with profound immune dysregulation, activation of clotting, and a severe microvascular injury culminating in severe hypoxemia. The core treatment strategy to manage the pulmonary phase includes the combination of methylprednisolone, ascorbic acid, thiamine, and heparin (MATH+ protocol). The rationale for the MATH+ protocol is reviewed in this paper.
We provide an overview on the pathophysiological changes occurring in patients with COVID-19 respiratory failure and a treatment strategy to reverse these changes thereby preventing progressive lung injury and death.
While there is no single 'Silver Bullet' to cure COVID-19, we believe that the severely disturbed pathological processes leading to respiratory failure in patients with COVID-19 organizing pneumonia will respond to the combination of Methylprednisone, Ascorbic acid, Thiamine, and full anticoagulation with Heparin (MATH+ protocol).We believe that it is no longer ethically acceptable to limit management to 'supportive care' alone, in the face of effective, safe, and inexpensive medications that can effectively treat this disease and thereby reduce the risk of complications and death.
COVID-19 疾病经历多个不同阶段进展。每个阶段的管理都是独特且特定的。COVID-19 的肺部阶段的特征是具有深刻免疫失调、凝血激活和严重微血管损伤的机化性肺炎，最终导致严重低氧血症。管理肺部阶段的核心治疗策略包括甲基强的松龙、抗坏血酸、硫胺素和肝素（MATH+方案）的联合应用。本文回顾了 MATH+方案的原理。
我们提供了对 COVID-19 呼吸衰竭患者中发生的病理生理变化的概述，并提供了一种治疗策略来逆转这些变化，从而防止进行性肺损伤和死亡。
虽然没有单一的“银弹”可以治愈 COVID-19，但我们相信，COVID-19 机化性肺炎导致呼吸衰竭的严重紊乱病理过程将对甲基强的松龙、抗坏血酸、硫胺素和充分抗凝的肝素（MATH+方案）联合治疗产生反应。我们认为，面对可有效治疗这种疾病并降低并发症和死亡风险的有效、安全且廉价的药物，仅将管理限于“支持性治疗”已不再符合伦理。
