Relief from Toxic Effects of Oxygen Using Succinates in Patients with COVID-19 Undergoing High-Flow Oxygen Therapy

Abstract

Liberal oxygen therapy for COVID-19 causes hyperoxemia in most patients and reduces their survival rate. Even moderate hyperoxemia reduces oxygen delivery, and high levels of oxygen in central venous blood increase mortality in COVID-19 patients. These facts occur due to the manifestation of toxic effects of oxygen (vasoconstriction, bronchoconstriction) requiring the use of medications that reduce toxic effects. The aim of the study was to assess the ability of succinate preparations to eliminate the toxic effects of oxygen affecting central hemodynamics and blood oxygenation in patients with COVID-19. Material and methods. The effect of medicines containing succinates (Cytoflavin and Reamberin) in stopping the manifestations of hyperoxia in 51 surviving patients with the novel coronavirus infection who received high-flow oxygen therapy (HFOT) was analyzed in a retrospective study. Results. Monitoring of heart rate, respiratory rate, SpO₂, PaO₂ and PaO₂/FiO₂ during HFOT within 12 hours from the start of oxygen therapy showed an indirect, but statistically significant effect of stopping the toxic effects of oxygen. This was expressed in a decrease in tachycardia and tachypnea [to 86.7–115.0 (at P<0.001) and 22–24 (P<0.001), respectively] against the background of concomitantly administered succinate preparations, that provided effective oxygen absorption and contributed to the effective elimination of hypoxia and hypoxemia (an increase in PaO₂/FiO₂ to 196.0 [(184.2–249.0) at P<0.001], which was confirmed by a dynamic decrease in the level of lactate (to 2.6±0.8 mmol/l at P<0.001). Conclusion. The results obtained indirectly confirm the protective effect of succinates, which are more pronounced in Citoflavin, but require additional confirmation of the hypothesis of succinate effectiveness in stopping the toxic effects of oxygen in further studies.