Respiratory support for adult patients with COVID-19
Respiratory support for adult patients with COVID-19
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DOI：
10.1002/emp2.12071
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发表时间：
2020-04-01
影响因子：
2.3
通讯作者：
Rosenberg, Mark S.
中科院分区：
文献类型：
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作者：
Whittle, Jessica S.;Pavlov, Ivan;Rosenberg, Mark S.
COVID-19大流行正在对医疗保健系统造成独特的压力。虽然只有一小部分患者需要机械通气和ICU护理，但受影响的人口规模巨大，这意味着这些关键资源可能会变得有限。有许多非侵入性的选择，以避免机械通气和ICU入院。这是对这些选择及其在成年COVID-19患者中的适用性的临床综述。总结建议包括：（1）避免雾化治疗。考虑定量吸入器替代品。(2)按照低氧性呼吸衰竭的常规治疗原则提供补充氧气。保持对所有设备的气溶胶生成潜力的认识，包括鼻插管、简易面罩和文丘里面罩。尽可能使用非再呼吸面罩。注意气溶胶的产生和个人防护设备的使用。(3)高流量鼻氧对于需要较高氧气支持的患者是首选。无创正压通气可能与更高的院内传播风险相关。如果使用，应采取特殊预防措施减少气溶胶形成。(4)早期插管/机械通气可能是谨慎的患者被认为可能进展到危重病，多器官功能衰竭，或急性呼吸窘迫综合征（ARDS）。
The COVID-19 pandemic is creating unique strains on the healthcare system. While only a small percentage of patients require mechanical ventilation and ICU care, the enormous size of the populations affected means that these critical resources may become limited. A number of non-invasive options exist to avert mechanical ventilation and ICU admission. This is a clinical review of these options and their applicability in adult COVID-19 patients. Summary recommendations include: (1) Avoid nebulized therapies. Consider metered dose inhaler alternatives. (2) Provide supplemental oxygen following usual treatment principles for hypoxic respiratory failure. Maintain awareness of the aerosol-generating potential of all devices, including nasal cannulas, simple face masks, and venturi masks. Use non-rebreather masks when possible. Be attentive to aerosol generation and the use of personal protective equipment. (3) High flow nasal oxygen is preferred for patients with higher oxygen support requirements. Non-invasive positive pressure ventilation may be associated with higher risk of nosocomial transmission. If used, measures special precautions should be used reduce aerosol formation. (4) Early intubation/mechanical ventilation may be prudent for patients deemed likely to progress to critical illness, multi-organ failure, or acute respiratory distress syndrome (ARDS).