COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
COVID-19 pandemic and non invasive respiratory management: Every Goliath needs a David. An evidence based evaluation of problems
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DOI：
10.1016/j.pulmoe.2020.04.013
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发表时间：
2020-07-01
期刊：
影响因子：
11.7
通讯作者：
Ambrosino, N.
中科院分区：
文献类型：
--
作者：
Winck, J. C.;Ambrosino, N.
背景和目标：抗击新型冠状病毒肺炎（COVID-19，即2019冠状病毒病）的战争远未取得胜利。本叙述性综述试图描述肺病学家在管理COVID-19引起的急性呼吸衰竭（ARF）方面存在的一些问题。研究方法：我们检索了以下数据库：MEDLINE、EMBASE、科克伦对照试验中心注册库，并对检索到的文献的参考文献进行了审查，以进行其他研究。检索仅限于以下术语：Covid-19 AND：急性呼吸窘迫综合征（ARDS）、SARS、MERS、无创通气（NIV）、高流量鼻插管（HFNC）、内旋（PP）、医护人员（HCW）。结果：对医护人员的保护应该是最重要的，因此需要配备完整的个人防护设备和负压室。HFNC单独或与PP可用于轻度病例（PaO 2/FiO 2在200 - 300之间）; NIV单独或与PP可用于中度病例（PaO 2/FiO 2在100 - 200之间）。旋转和耦合（HFNC/NIV）策略可能是有益的。建议1- 2小时的机会窗口。如果PaO 2/FIO 2显著增加，呼吸频率降低，呼气潮气量相对较低，则无创策略可能有效，插管延迟。结论：尽管非侵入性呼吸治疗在COVID-19 ARF的背景下发挥了作用，但仍需要更多的研究来确定患者和HCW的获益和风险平衡。间接地，非侵入性呼吸治疗可能特别有利于通过避免插管（一种潜在的高传染性手术）来降低医护人员的风险。(c)2020年葡萄牙石油学会。由Elsevier Espan出版，类似于a，S.L.U.这是CC BY -NC -ND许可下的开放获取文章（http：creativecommons.org/licenses/by- nc-nd/4.0/）。
Background and aim: The war against Covid-19 is far from won. This narrative review attempts to describe some problems with the management of Covid-19 induced acute respiratory failure (ARF) by pulmonologists. Methods: We searched the following databases: MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and reviewed the references of retrieved articles for additional studies. The search was limited to the terms: Covid-19 AND : acute respiratory distress syndrome (ARDS), SARS, MERS, non invasive ventilation (NIV), high flow nasal cannula (HFNC), pronation (PP), health care workers (HCW). Results: Protection of Health care workers should be paramount, so full Personal Protective Equipment and Negative pressure rooms are warranted. HFNC alone or with PP could be offered for mild cases (PaO2/FiO2 between 200 - 300); NIV alone or with PP may work in moderate cases (PaO2/FiO2 between 100 - 200). Rotation and coupled (HFNC/NIV) strategy can be beneficial. A window of opportunity of 1--2 h is advised. If PaO2/FIO2 significantly increases, Respiratory Rate decreases with a relatively low Exhaled Tidal Volume, the non-invasive strategy could be working and intubation delayed. Conclusion: Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients and HCW. Indirectly, non invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure. (c) 2020 Sociedade Portuguesa de Pneumologia. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY -NC -ND license (http://creativecommons.org/licenses/by- nc-nd/4.0/).