Proposal for Coronavirus Disease 2019 Management.

Autor:	Downs JB; Departments of Anesthesiology and Critical Care Medicine, University of Florida College of Medicine, Gainesville, FL.; Departments of Anesthesiology and Critical Care Medicine, University of South Florida College of Medicine, Tampa, FL., Weled B; Franciscan Medical Center Tacoma Washington, Tacoma, WA., Räsänen J; Mayo Clinic College of Medicine and Science, Rochester, MN., Haines KL; Department of Surgery, Trauma and Critical Care Medicine, Duke University, Durham, NC., Vidyasagar D; Division of Neonatology, University of Illinois at Chicago, Chicago, IL., Stock MC; Northwestern University Feinberg School of Medicine, Chicago, IL., Habashi N; University of Maryland School of Medicine, Multi-Trauma Critical Care Unit, R Adams Cowley Shock Trauma Unit, Baltimore, MD.
Jazyk:	angličtina
Zdroj:	Critical care explorations [Crit Care Explor] 2020 May 12; Vol. 2 (5), pp. e0127. Date of Electronic Publication: 2020 May 12 (Print Publication: 2020).
DOI:	10.1097/CCE.0000000000000127
Abstrakt:	Setting: The coronavirus disease 2019 pandemic has raised fear throughout the nation. Current news and social media predictions of ventilator, medication, and personnel shortages are rampant. Patients: Patients with coronavirus disease 2019 are presenting with early respiratory distress and hypoxemia, but not hypercapnia. Interventions: Patients who maintain adequate alveolar ventilation, normocapnia, and adequate oxygenation may avoid the need for tracheal intubation. Facemask continuous positive airway pressure has been used to treat patients with respiratory distress for decades, including those with severe acute respiratory syndrome. Of importance, protocols were successful in protecting caregivers from contracting the virus, obviating the need for tracheal intubation just to limit the spread of potentially infectious particles. Conclusions: During a pandemic, with limited resources, we should provide the safest and most effective care, while protecting caregivers. Continuous positive airway pressure titrated to an effective level and applied early with a facemask may spare ventilator usage. Allowing spontaneous ventilation will decrease the need for sedative and paralytic drugs and may decrease the need for highly skilled nurses and respiratory therapists. These goals can be accomplished with devices that are readily available and easier to obtain than mechanical ventilators, which then can be reserved for the sickest patients. Competing Interests: Dr. Habashi has received reimbursement for travel to conferences sponsored in part by Drager and has several patents in the area of mechanical ventilation and its application. To date, he has not received any royalties or payments for any patents. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2020 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine.)
Databáze:	MEDLINE
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