Sabba Antonio, Pontoni Giancarlo, Santangelo Maria, Rachedi Nadir, D'Ercole Maurizio, Marseglia Bernardino, Fusaro Marcella, Bignami Elena Giovanna, Fontana Costantino
Rome Military Hospital-Policlinico Militare Di Roma, Rome, Italy.
Foligno Army Selection Center, Foligno, Italy.
J Anesth Analg Crit Care. 2023 Sep 15;3(1):35. doi: 10.1186/s44158-023-00114-6.
Four-hundred forty-nine patients affected by Covid-19 were hospitalized at the Rome Military Hospital between March 2020 and July 2022. Depending on the severity of the disease, they were assigned either to the Functional Health Emergency Unit - if suffering from interstitial pneumonia with a clinical manifestation of dyspnea associated with peripheral oxygen saturation < 92%, and oxygen atmospheric pressure therapy - or to the intensive care unit - if the blood gas-lytic index P/F (ratio between partial pressure of arterial O2 and inspired fraction of O2) was below 150. This prospective observation and monocentric study aim to verify the outcome (healing/death) of early use of remdesivir in pneumonia patients.
The results highlight the importance of the adoption of remdesivir in the initial stages of infection to prevent the systemic spread and viral multiplication and, in the subsequent phase, a cytokine storm resulting in acute respiratory failure and multiorgan failure. The use of the drug in the most advanced stages of the disease is not associated with a real impact on patient outcomes. Therefore, there is a statistically significant correspondence between the early use of remdesivir in the treatment of SARS-CoV-2 disease - in addition to guidelines therapies - and a favorable clinical outcome.
This work shows therapeutic efficacy in the first 5 days of intravenous administration of remdesivir, following the loading dose. It is also necessary to underline the different behaviors of the drug when administered late in patients undergoing mechanical ventilation, compared to those who only needed low-flow oxygen therapy, whose share of recovery - decidedly relevant - reaches statistical significance.
2020年3月至2022年7月期间，449名新冠肺炎患者在罗马军事医院住院。根据疾病的严重程度，若患者患有间质性肺炎且伴有呼吸困难临床表现及外周血氧饱和度<92%，则被分配至功能健康急救单元，并接受常压氧疗；若血气溶解指数P/F（动脉血氧分压与吸入氧分数之比）低于150，则被分配至重症监护病房。这项前瞻性观察性单中心研究旨在验证早期使用瑞德西韦对肺炎患者的治疗结果（治愈/死亡）。
结果凸显了在感染初期采用瑞德西韦以防止病毒全身扩散和增殖的重要性，以及在后续阶段防止细胞因子风暴导致急性呼吸衰竭和多器官衰竭的重要性。在疾病最晚期使用该药物对患者治疗结果并无实际影响。因此，除遵循指南治疗外，早期使用瑞德西韦治疗新冠病毒疾病与良好的临床结果之间存在统计学上的显著相关性。
这项研究表明，在给予瑞德西韦负荷剂量后，静脉注射该药的前5天具有治疗效果。还需强调的是，与仅需要低流量氧疗的患者相比，在接受机械通气的患者中晚期使用该药物时会出现不同的情况，前者的康复比例——显然很高——具有统计学意义。
