[Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia].
[Expert consensus on preventing nosocomial transmission during respiratory care for critically ill patients infected by 2019 novel coronavirus pneumonia].
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DOI：
10.3760/cma.j.issn.1001-0939.2020.0020
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发表时间：
2020-02-20
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明确的证据表明，新型冠状病毒（COVID-19）可以在人与人之间传播，迄今已有1，700多名临床医生被感染。很多危重症患者的呼吸道治疗被认为是院内传播的高危因素，如插管、人工呼吸机人工通气、无创通气、高流量鼻插管、支气管镜检查、吸痰和患者转运等，因其极有可能引起或加重病毒的传播。因此，我们根据目前的证据以及某些地区的资源限制，就所有这些高风险治疗制定了这一共识建议，旨在减少院内传播并优化COVID-19肺炎患者的治疗。这些建议包括：（1）规范预防防护，隔离患者;（2）HFNC治疗时患者佩戴口罩;（3）使用双肢呼吸机，呼吸机出口放置过滤器，或使用热湿交换器（HME）代替单肢呼吸机中的加热加湿，HME放置在呼气口和面罩之间;避免使用呼气口在面罩上的面罩;（4）在复苏器与面罩或人工气道之间放置过滤器;（5）对于自主呼吸患者，在支气管镜检查时为患者放置面罩;对于无创通气患者，使用带有支气管镜端口的专用面罩进行支气管镜检查;（6）插管时使用镇静剂和麻醉剂，套囊压力维持在25-30 cmH（2）O;（7）建议使用In-line吸引导管，可使用一周;（8）建议使用双肢加热线电路，仅在可见脏污时更换;（9）对于在运输过程中需要呼吸支持的患者，在呼吸机和患者之间放置HME;（10）PSV建议用于实施自主呼吸试验（SBT），避免使用T形件进行SBT。气管切开患者撤机时，应使用HME，避免使用T型或气管切开面罩。(11)避免不必要的支气管卫生治疗;（12）对于需要雾化治疗的患者，自主呼吸的患者建议使用干粉吸入器定量吸入器，雾化时建议使用振动网孔式雾化器，并在通气的呼气口放置额外的过滤器。
Definite evidence has shown that the novel coronavirus (COVID-19) could be transmitted from person to person, so far more than 1,700 bedside clinicians have been infected. A lot of respiratory treatments for critically ill patients are deemed as high-risk factors for nosocomial transmission, such as intubation, manual ventilation by resuscitator, noninvasive ventilation, high-flow nasal cannula, bronchoscopy examination, suction and patient transportation, etc, due to its high possibility to cause or worsen the spread of the virus. As such, we developed this consensus recommendations on all those high-risk treatments, based on the current evidence as well as the resource limitation in some areas, with the aim to reduce the nosocomial transmission and optimize the treatment for the COVID-19 pneumonia patients. Those recommendations include: (1) Standard prevention and protection, and patient isolation; (2) Patient wearing mask during HFNC treatment; (3) Using dual limb ventilator with filters placed at the ventilator outlets, or using heat-moisture exchanger (HME) instead of heated humidification in single limb ventilator with HME placed between exhalation port and mask; avoid using mask with exhalation port on the mask; (4) Placing filter between resuscitator and mask or artificial airway; (5) For spontaneous breathing patients, placing mask for patients during bronchoscopy examination; for patients receiving noninvasive ventilation, using the special mask with bronchoscopy port to perform bronchoscopy; (6) Using sedation and paralytics during intubation, cuff pressure should be maintained between 25-30 cmH(2)O; (7) In-line suction catheter is recommended and it can be used for one week; (8) Dual-limb heated wire circuits are recommended and only changed with visible soiled; (9. For patients who need breathing support during transportation, placing an HME between ventilator and patient; (10) PSV is recommended for implementing spontaneous breathing trial (SBT), avoid using T-piece to do SBT. When tracheotomy patients are weaned from ventilator, HME should be used, avoid using T-piece or tracheostomy mask. (11) Avoid unnecessary bronchial hygiene therapy; (12) For patients who need aerosol therapy, dry powder inhaler metered dose inhaler with spacer is recommended for spontaneous breathing patients; while vibrating mesh nebulizer is recommended for ventilated patients and additional filter is recommended to be placed at the expiratory port of ventilation during nebulization.