Conservative Management of COVID-19 Patients-Emergency Palliative Care in Action
Conservative Management of COVID-19 Patients-Emergency Palliative Care in Action
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DOI：
10.1016/j.jpainsymman.2020.03.030
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发表时间：
2020-07-01
影响因子：
4.7
通讯作者：
Gamondi, Claudia
中科院分区：
文献类型：
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作者：
Fusi-Schmidhauser, Tanja;Preston, Nancy J.;Gamondi, Claudia
上下文。新冠肺炎大流行正在全球蔓延。由于潜在的健康状况，许多患者不适合机械通气，他们将需要保守的方法，包括对他们的重要症状负担进行姑息治疗。为不适合机械通气的患者制定适合其分期的新冠肺炎管理方案。使用新冠肺炎的早期预警参数，患者被识别为稳定、不稳定或生命末期。此外，当地还开发了COVID-19专用评估工具，重点关注在该人群中观察到的评估呼吸困难、痛苦和不适的关键症状。该工具有助于根据患者的病情分期指导姑息治疗的管理。在急诊医院制定并实施了针对所有患者(稳定、不稳定、临终)的管理计划。用药指南是基于资源和药物可获得性的限制。不熟悉姑息治疗的工作人员需要遵循简单、明确的说明，包括治疗呼吸困难、痛苦、发烧和不适等关键症状的药物。根据患者的病情分期和感染控制要求，采取相应的护理干预措施和家庭参与。新冠肺炎大流行期间的姑息治疗需要适应紧急姑息治疗的风格，因为患者的病情可能会迅速恶化，需要迅速做出决定和明确的治疗计划。这些需要由照顾这些患者的多面手工作人员轻松跟进。此外，姑息治疗应该走在前列，帮助做出最好的决定，照顾家庭，并提供精神支持。(C)2020年美国临终关怀与姑息医学学会。爱思唯尔公司出版，版权所有。
Context. The COVID-19 pandemic is spreading across the world. Many patients will not be suitable for mechanical ventilation owing to the underlying health conditions, and they will require a conservative approach including palliative care management for their important symptom burden.Objectives. To develop a management plan for patients who are not suitable for mechanical ventilation that is tailored to the stage their COVID-19 disease.Methods. Patients were identified as being stable, unstable, or at the end of life using the early warning parameters for COVID-19. Furthermore, a COVID-19especific assessment tool was developed locally, focusing on key symptoms observed in this population which assess dyspnoea, distress, and discomfort. This tool helped to guide the palliative care management as per patients' disease stage.Results. A management plan for all patients' (stable, unstable, end of life) was created and implemented in acute hospitals. Medication guidelines were based on the limitations in resources and availability of drugs. Staff members who were unfamiliar with palliative care required simple, clear instructions to follow including medications for key symptoms such as dyspnoea, distress, fever, and discomfort. Nursing interventions and family involvement were adapted as per patients' disease stage and infection control requirements.Conclusion. Palliative care during the COVID-19 pandemic needs to adapt to an emergency style of palliative care as patients can deteriorate rapidly and require quick decisions and clear treatment plans. These need to be easily followed up by generalist staff members caring for these patients. Furthermore, palliative care should be at the forefront to help make the best decisions, give care to families, and offer spiritual support. (C) 2020 American Academy of Hospice and Palliative Medicine. Published by Elsevier Inc. All rights reserved.